Pain in the early postoperative period was inferior on the side where the self-adhesive mesh had been implanted (6.12 vs. 6.62, p=0.005 during the 1st postoperative day; 2.12 vs. 2.62, p=0.001 during the 7th postoperative day). Differences disappeared with the long-term evaluation (0.71 vs. 0.98, p=0.148 1 year after the surgery). The operative time was significantly shorter on the PPG mesh side (24.37 ± 5.1 in case of the PPG mesh and 29.66 ± 5.6 in case of the PLP mesh, p<0,001). Recurrence occurred in seven patients (7.8%), six of them (6.7%, CI 3.0-14.4) on the PPG mesh side and one (1.1%, CI 0.2-7.8) on the PLP side. These differences were not statistically significant (p=0.125) CONCLUSIONS: Although hernioplasty with self-adhesive mesh reduced early postoperative pain, this reduction was clinically irrelevant and it had no influence on chronic pain. There was a trend towards a higher recurrence rate when self-adhesive meshes were used, and although in this study differences were not statistically significant they should be confirmed in later studies using larger samples. Surgical procedures that do not need fixing sutures are promising, but further studies are needed before they become the gold standard of inguinal hernia repair.

Prevalence of NASH among patients with gallstones is lower than estimated previously, but NASH is frequent particularly in those patients with concurrent metabolic syndrome. The combination of an increased HOMA score with fatty liver on ultrasound has a good accuracy for predicting NASH in patients with gallstones.

No abstract

There is a lack of consensus about the surgical management of umbilical hernias. The aim of this study is to analyze the medium-term results of 934 umbilical hernia repairs. In this study, 934 patients with an umbilical hernia underwent surgery between 2004 and 2010, 599 (64.1%) of which were evaluated at least one year after the surgery. Complications, recurrence, and the reoperation rate were analyzed. Complications were observed in 5.7 per cent of the patients. With a mean follow-up time of 35.5 months, recurrence and reoperation rates were 3.8 per cent and 4.7 per cent, respectively. A higher percentage of female patients (60.9 % vs 29 %, P = 0.001) and a longer follow-up time (47.4 vs 35 months, P = 0.037) were observed in patients who developed a recurrence. No significant differences were observed between complications and the reoperation rate in patients who underwent Ventralex® preperitoneal mesh reinforcement and suture repair; however, a trend toward a higher recurrence rate was observed in patients with suture repair (6.5 % vs 3.2 %, P = 0.082). Suture repair had lower recurrence and reoperation rates in patients with umbilical hernias less than 1 cm. Suture repair is an appropriate procedure for small umbilical hernias; however, for larger umbilical hernias, mesh reinforcement should be considered.

Summary:The anterior open tension-free hernioplasty popularized by the Lichtenstein group has gained world-wide acceptance and popularity. As described by the same group, utilization of a small sheet of mesh and failure to overlap the mesh with the pubic tubercle can lead to recurrence of the hernia. However, recurrence through the internal ring has not been reported. We report three recurrences from the internal ring area after open tension-free hernioplasty. The cause is discussed and the importance of making a mesh shutter mechanism at the internal ring in order to prevent indirect recurrence, is emphasized.Key words: Reccurrences -Anterior -Open -Tension-free -HernioplastyCorrespondence to: A. Celdr~n Received ]uly, 12, 1999 Accepted in final form April, 17, 2000 Analysis of recurrences following different methods of hernia repair is an important aspect of any series. Through better understanding of the mechanism of recurrence, the surgeon is able to refine the technique and thus prevent the recurrence. However, surgeons rarely have the opportunity to repair their own recurrences, and indeed, in most series, the reason for recurrence following the use of a specific operation :is not described. The anterior open tension-free mesh repair of inguinal hernia, described by the Lichtenstein group [Amid 1998], has simplified the application of tensionfree principles compared with other techniques which place the prosthesis in the properitoneal space [Stoppa 1984]. The former allows routine performance under local anesthesia in an ambulatory facility and achieves the same or a lower recurrence rate but with a shorter period of disability. In a critical scrutiny of their own procedure, Amid et al reported that inadequate mesh size and failure to overlap the mesh with the pubic tubercle can lead to recurrences below or above the mesh or at the pubic tubercle [Amid 1993]. This observation led to the group's recommendation to overlap the mesh with the pubic tubercle and utilize a wider mesh in order to provide sufficient contact between the mesh and tissue beyond the inguinal floor, as well as to provide adequate laxity for the mesh to compensate for the increased intra-abdominal pressure. The importance of using a wider mesh and allowing a certain degree of laxity became more obvious when they proved that after implantations the mesh decreases its size up to 2o% due to shrinkage [Amid 1997]. The purpose of this article is to report another cause of recurrence : when construction of the internal ring is not made in such a way as to create a shutter mechanism as described in the original Lichtenstein technique [Amid 1998 ] . Patients and resultsFrom October 1991 to December 1997 32o inguinal hernias were operated on, in 296 patients by one of the authors (AC) or residents assisted by him. Mean follow up was 44.6 m o n t h s (range 23 to 98). A 54-year-old man presented asymptomatic recurrence t h r o u g h the deep ring close to the spermatic cord 44 months postoperatively. Symptomatic recurrences were found in t...