Clinical dilemma. A hernia sac cannot be found at operation.
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Biomedical subjects
Publications and source records attributed to K J Waters.
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The technical problems, early complications and short-term results of a tension-free method of 1098 inguinal hernia repairs in 1017 patients have been assessed. The operation was conducted under local anaesthesia, and the inguinal canal floor was reinforced by a polypropylene mesh. Patients were discharged home the same day. There was no mortality, no urinary complications and one case of venous thrombosis. There was one recurrence after a primary hernia repair and two patients have developed recurrences after repair of a recurrent hernia. The overall sepsis rate was 0.9% and 1% of patients had persistent neuralgia. No prosthesis required removal. In all, 49.6% of office workers returned to work in 1 week or less and 61% of manual workers in 2 weeks or less. The major advantages of the tension-free mesh repair under local anaesthesia are simplicity, substantial cost savings and very low rates of complications.
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In a randomized double-blind controlled trial the effect of naftidrofuryl (Praxilene) 200 mg t.d.s., taken for 6 months, was compared with placebo in intermittent claudication. Whilst there was a significant subjective improvement regardless of age or treatment, patients over 60 on naftidrofuryl experienced a more rapid symptomatic relief than other patients. At six months this age group showed a significant improvement over the placebo group. There was no significnat objective evidence of improvement.
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