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Background and Objective: Appropriate analgesia after surgery helps patients feel more comfortable and increase the mobility of them. The purpose of this study was to compare the effect of subcutaneous injection of Ketamine and Lidocaine in reducing postoperative pain in patients undergoing elective inguinal hernia surgery under general anesthesia. Methods: This double blinded, randomized clinical trial study was done on 60 patients undergoing elective inguinal hernia under general anesthesia. Subjects were randomly assigned into three groups including control, Ketamine and Lidocaine groups. Subjects in Ketamine group were received infiltration of subcutaneous Ketamine 0.5 mg/kg/bw after closure of surgical incision. Subjects in Lidocaine group were received infiltration of subcutaneous Lidocaine 1 mg/kg/bw at the time of wound suturing. Subjects in control group did not receive Ketamine and Lidocaine. The visual analogue scale (VAS) of pain and vital signs were continuously assessed. If VAS≥3, 100 mg diclofenac suppository was administered and if there were no response, 30 mg intravenous pethidine was also administered. The complications, including hallucination, nystagmus, nausea, vomiting and drowsiness in patients were also recorded. Results: The mean VAS at 1, 2 hours after surgery were significantly lower in the Ketamine and Lidocaine group in compared to control group (P<0.05). No significant adverse effect was observed in the Ketamine group. Conclusion: For reduction of pain, administration of subcutaneous Ketamine is recommended due to no adverse effect and anti analgesic effect of Ketamine is similar to Lidocaine. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia is a common surgical problem which increases with aging especially in men. A common method for treatment is surgical repair using prosthesis, Lichtenstein technique. One frequent complication after inguinal herniorrhaphy is soft tissues seroma. There are several methods to prevent or to drain seroma. Some surgeons suggest the insertion of closed suction drainage system but others disagree. Methods: In this clinical trial study, 42 patients who are candidate for hernia repairing (Lichtenstein technique), referred to Amir Al-Momenin Hospital in Semnan, Iran, from 2011 to 2012, were randomly divided into two groups. So that, the list of eligible patients in the study, were numbered, and then using the patients' code, patients, who assigned an odd number in the registration list, were allocated to group 1, the remainder were placed in group two. The two first numbers in registration list (1 or 2), were randomly assigned to groups. Group 1 underwent hernia surgery without closed suction drainage and the second group underwent hernia surgery with closed suction drainage. The patients were evaluated for seroma, hematoma or wound infection after 24 hours, during days 4 to 7 and days 10 to 15 following surgery. Results: No adverse event including hematoma, seroma or wound infection occurred in either group with or without closed suction drainage in the first 10 days after surgery. Only one patient carried wound infection during days 10 to 15 following operation who was in the group with closed drainage (P=1.00). Conclusion: In this study, Seroma and hematoma was not observed in patients with and without closed suction drainage. To avoid drains' complications, indiscriminate use of antibiotics, prolonged hospital stay, we do not recommend the use of drains in this type of surgery. [ABSTRACT FROM AUTHOR]

Background: Familiarity with different methods and medications in anesthesia and producing sufficient depth of anesthesia are very important in anesthesia practice. Due to the central analgesic and sedative effect of lidocaine in the presence of the sufficient blood level, it can be used for general anesthesia. This study was carried out to compare the effect of halothane with lidocaine infusion on BIS during maintenance of anesthesia. Materials and Methods: In this randomized double-blind controlled clinical trial, 66 patients scheduled for elective inguinal herniorrahaphy were randomized into two equal groups. For maintenance, one group received halothane (1%) with O2-N2O and another group received lidocaine infusion (100 &mug/kg/min). BIS was checked every 5 minutes for half an hour. Statistical analysis of data was done by Chi-square and T-test through SPSS software. P-values less than 0.05 were considered meaningful. Results: Mean of BIS was 65.72 in the lidocaine group and 56.7 in the halothane group during the first 30 minutes. There was a significant statistical difference between the two groups (p<0.05). Conclusion: Mean of BIS in lidocaine group was higher than that in the halothane group. If this indicates the presence of a light level of anesthesia, increasing the dose of hypnotics and opioids leads to an increase in the depth of anesthesia. However, since there is not any device for monitoring the effect of opioids on the central nervous system and the level of anesthesia, simultaneous monitoring of BIS and hemodynamic parameters seems to be a more reasonable idea. [ABSTRACT FROM AUTHOR]

Background: According to increasing use of ultrasound in the diagnosis of inguinal herniation, this study was designed to evaluate the cross-sectional area of the inguinal canal in patients with inguinal herniation and its increase with Valsalva maneuver. We also compared the obtained values with those of normal population. Methods: a cross-sectional study, 52 normal persons and 35 cases with inguinal hernia were assessed. The cross-sectional area of the inguinal canal was measured in all subjects and data was analyzed using Student's t-test and Pearson's correlation tests in SPSS. Receiver operator characteristic (ROC) curves were traced to define cut-off points. Findings: Valsalva maneuver caused significantly greater increase in the cross-sectional area of the inguinal canal among patients than in the normal group. The cut-off point of the cross-sectional area of inguinal canal was 63.5 mm2 in neutral state and 72.5 mm2 with Valsalva maneuver (increase rate: 34 mm2). In the absence of Valsalva maneuver, a cross-sectional area of the inguinal canal of greater than 63.5 mm2 is predictive of inguinal hernia (with 91% sensitivity and 98% specificity). Otherwise, values greater than 72.5 mm2 will be predictive of inguinal hernia (with 100% sensitivity and 98% specificity). Inguinal hernia will also be suspected if Valsalva maneuver increases the cross-sectional area of the inguinal canal by more than 34 mm2 (with 91% sensitivity and 100% specificity). Conclusion: The following diagnostic criteria are suggested for diagnosis of inguinal hernia through ultrasound examination: the presence of bowel loop within the inguinal canal, a cross-sectional area of the inguinal canal > 63.5 mm2 without Valsalva maneuver and > 72.5 mm2 with Valsalva maneuver, an increase of > 34 mm2 in the cross-sectional area of the inguinal canal with Valsalva maneuver, and a > 0.5 cm movement of the spermatic cord with Valsalva maneuver. [ABSTRACT FROM AUTHOR]

Background: There are many controversies about relationship between hernias and connective tissue disorders in children. The aim of this study was to determine the relationship of benign joint hypermobility syndrome (BHJS) with inguinal hernias in children. Methods: This descriptive analytical study involved children of 2-12 years old who were diagnosed with inguinal hernia during 2009-11. Subjects were admitted to pediatric or pediatric surgery wards of hospital affiliated with Isfahan University of Medical Sciences (Iran). Overall, 200 children in two groups of patients with inguinal hernias and controls were included. Beighton score was used for diagnosis of BHJS in the admitted children and the control group. For evaluation of collected data and the relationship of diseases, we used SPSS18 and chi-square test. Findings: The mean Beighton score was 6.2 ± 2.0 in the case and 2.7 ± 2.2 in the control group, i.e. children with inguinal hernias had significantly higher Beighton scores (P < 0.001). Conclusion: Based on this study, BHJS is prevalent in children with inguinal hernias. Therefore, in every patient with inguinal hernias, the presence of concomitant BHJS should also be considered. [ABSTRACT FROM AUTHOR]

Background: Inguinoscrotal hernia of the bladder is a rare clinical entity. Bladder herniation is commonly small, clinically silent, and incidentally detected during elective hernioplasty. Bladder resection is indicated if tumor or necrosis is detected. Few cases of bladder herniation containing neoplasia have been reported and usually discovered intraoperatively. Case Report: We herein reported our experience with 3 inguinoscrotal bladder hernias treated with partial cystectomy and routine herniorrhaphy. One patient had high grade superficial transitional cell carcinoma and one had bladder stone. Conclusion: Despite the 3 layers of the bladder being normal, it seems reasonable to manage cases of massive inguinoscrotal bladder hernia accompanied by stone or tumor like acquired diverticular disease by diverticular excision (partial cystectomy). [ABSTRACT FROM AUTHOR]

Background and purpose: Surgical site infections are infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure, and the development of SSIs is related to the degree of microbial contamination of wound during surgery, duration of the procedure, and host factors. Inguinal hernioplasty is one of the most common surgical operations. The use of prophylactic antibiotic in Lichtenstein hernioplasty is controversial. Hence this study done to evaluate the prophylactic antibiotic effect in reducing the post operative wound infection in Lichtenstein hernioplasty. Materials and methods: This is an interventional double-blind randomized trial on 282 patients under going, Unilateral primary elective inguinal hernioplasty with Lichtenstein method. Using polypropylene mesh. They were randomized to receive 1gr/1v cephalotin (keflin) or equal volume of placebo 30min before incision. Patients were evaluated 1week, 2weeks and 12weeks after surgery by an independent surgeon or resident. Wound infection was defined according to the criteria of centers for Disease control and recorded. Results were assessed using chi-square and t-test as appropriate. Results: We included 282 patients in this study between March 2010 and october 2011. The total number of wound infection was 13 (4.7%), 4(2.8%) in antibiotic group and 9(6.4%) in placebo group (p= 0.29). There was 1 deep infection only in placebo group. Statistical analysis showed no significant difference in two groups. Conclusion: The results show that, in Lichtenstein hernioplasty, routine use of prophylactic antibiotic is not indicated, as it does not significantly reduce the post operative surgical site infection rates. [ABSTRACT FROM AUTHOR]

Background: Non-steroidal anti-inflammatory drugs (NSADs) and opioids are frequently administered to relieve postoperative pain. Uncontrolled postoperative pain may produce a range of detrimental acute and chronic health consequences and increase mortality and morbidity. Practically, the analgesic efficacy of opioids is typically limited by the development of tolerance to them or by opioid-related sideeffects such as nausea, vomiting, sedation or respiratory depression. This study aims to assess the effects of suppository diclofenac on post-herniorrhaphy pain management. Methods: In this prospective double-blind clinical trial, 60 patients who were candidate for the surgical repair of inguinal hernia were divided into two groups. Patients in group A received 100 mg of suppository diclofenac and patients in group B 50 mg of pethidine after the induction of anesthesia and before surgical incision. Postoperative pain assessment was done by an unbiased observer on the arrival of patients in the recovery room, using a 10-cm visual analogue scale (VAS) at 2-hour intervals for 6 hours. Results: Pain relief was similar in the two groups (P=0.3). Patients in group B required more analgesia two hours post-operatively (P=0.03), while patients in group A had more favorable results regarding pain control (P<0.05). Statistically, there was no difference between the two groups at other intervals. The occurrence of nausea and vomiting was similar in both groups. No respiratory depression was observed in the patients. Conclusion: Preventive analgesia with 100 mg of suppository diclofenac after anesthesia induction for herniorrhaphy produced effective postoperative analgesia with minimum side-effects. [ABSTRACT FROM AUTHOR]

Background: Inguinal herniotomy is the most common operation in pediatric surgery. The aim of this study was comparison of two methods of herniotomy with and without opening of external oblique muscle fascia. Methods: 49 patients with inguinal hernia was surveyed in two groups. 25 PT was operated without opening and 24 PT with opening of facia from 2006 lun -2007 lun. Data of age sex post operative complications (score of pain and firmness of wound) Time of surgery and anesthesia were analyzed with T -Test and X2 and P < 0.05 was meaningful. Finding: No meaningful different was about age and sex between the two groups but score of post operative pain and firmness, mean of operative and anesthetic times were loss significantly in without opening fascia group (P = 0.000) . No recurrence of hernia was observed as follow as one year. Conclusion: Inguinal herniotomy without opening of fascia was effective as another procedure with more less complications and duration of operation and anesthesia. [ABSTRACT FROM AUTHOR]

Background: The inguinal hernia is a common disorder in general surgery. Different methods have been described for repair of these hernias. In modern methods, synthetic mesh is used to cover the wall defect and the most known method is Lichtenstein surgical repair. The laparoscopic totally extra peritoneal procedure (TEP) is a newer technique of repairing hernia. The aim of this study is to compare the outcomes of totally extraperitoneal laparoscopic inguinal hernia repair versus Lichtenstein open repair in patients with inguinal hernia. Methods: Among 50 patients, 25 cases underwent Lichtenstein procedure and 25 patients underwent TEP technique for repairing primary unilateral inguinal hernia. Findings during the operation have been recorded and the 12-months follow-up of patients in different views was performed through a questionnaire and then the results were compared. Results: The operation duration, the rate of complications and frequency of recurrence were similar in two groups; but the hospital stay, postoperative pain, chronic groin pain and the required time to return to normal activity were significantly lower in patients who underwent the TEP method compared to the patients who underwent the Lichtenstein technique (p<0.001, p<0.001, p=0.012, p<0.001, respectively). Conclusion: The TEP surgical technique can be recognized as a safe method with acceptable results for patients and has significant effects on improvement of patients' quality of life after hernia repair. Suitable results of this surgical method are achieved when the surgeon goes through the learning curve. [ABSTRACT FROM AUTHOR]