[Laparoscopic inguinal hernia surgery: (for the time being) marking time].
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Biomedical subjects
Publications and source records attributed to R J Ponsen.
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A patient is presented with signs mimicking deep venous thrombosis of the leg, which proved to be compression of the femoral vein, without thrombosis, caused by a large cyst from the adjacent hip joint. Clinical presentation, diagnostic imaging procedures and therapy are presented with a review of the literature.
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Four techniques to close the fascia after midline laparotomy were compared in a prospective randomized multicentre trial. The four techniques were: interrupted closure with polyglactin; continuous closure with polyglactin; continuous closure with polydioxanone-s, and continuous closure with nylon. The early postoperative results in 1491 patients revealed an incidence of wound infection of 8.6 per cent and of wound dehiscence of 2.3 per cent with no statistically significant differences between the four techniques. We reviewed 1156 patients after 1 year. Wound pain was present in 9.7 per cent of the patients, statistically significantly more in the group closed with nylon (16.7 per cent). Suture sinuses developed in 3.5 per cent of the patients, statistically significantly more frequently in the nylon group (7.7 per cent). The total number of incisional hernias detected 1 year postoperatively was high (15.2 per cent) (interrupted polyglactin 16.9 per cent, continuous polyglactin 20.6 per cent, continuous polydioxanone 13.2 per cent and continuous nylon 10.3 per cent). The difference between nylon and continuous polyglactin is statistically significant. The results of this trial indicate that although nylon has the lowest incidence of incisional hernia it also is associated with more wound pain and suture sinuses.
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During the period from 1 January 1973 to 31 December 1978, 71 fractures of the carpal scaphoid were treated, 52 conservatively and 19 by primary surgery. For fractures treated conservatively, 12 weeks' immobilization is ample; in our opinion it may be reduced to 8-9 weeks for intracapsular and to 4 weeks for extracapsular fractures. The investigation by Alho et al. proves that immobilization of the elbow joint does not improve results, so that a short circular cast suffices.
The results of treatment of 52 supracondylar fractures of the humerus in children by means of percutaneous transfixation with two Kirschner wires are discussed and compared with the results of other methods of treatment, such as repositioning and immobilization in a plaster cast, and traction by the Baumann or Dunlop techniques. The functional results are equivalent to those of other methods of treatment. Although the number of cases studied was only small, it appears that the cosmetic results are better, while the duration of hospitalization is markedly shorter.
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