Groin hernia is common, and each year 200 repairs per 100 000 adult inhabitants are performed in Sweden. Groin hernias are either inguinal or femoral (2-4%). Elective repair is not associated with an excess mortality, but adverse outcomes include recurrence and long-term pain. Emergency procedures have a 4% mortality rate with an increased risk for bowel resection and postoperative complications. The aim of this thesis was to identify risk factors for adverse outcomes and to propose measures to improve groin hernia treatment. Twenty-three per cent of female hernias were femoral. Thirty-six per cent of femoral hernias, and 5% of inguinal hernias, have emergency procedures. Females (OR 1.47) and patients above 65 years-of-age (OR 2.24) were at higher risk for emergency repair. Bowel resection was performed in 23% of emergency femoral repairs, and the 30-day mortality was 10 times that of an age- and gender-matched population. The majority of emergency patients were unaware of their hernia, and one third had previously had no groin symptoms. Femoral repairs were at larger risk for recurrence than inguinal repairs. The surgical techniques with least risk for recurrence were preperitoneal mesh repairs (open HR 0.28, and laparoscopic HR 0.31). Long-term pain was present in 24% of femoral hernia patients, of whom 5.5% described pain interfering with daily activities. The only factor predicting the risk for long-term pain was pain preoperatively. Pain decreased with time. In a randomized study on inguinal hernia, TEP resulted in less pain six weeks after surgery than Lichtenstein repair performed under local anesthesia (LLA). TEP patients were to a larger extent able to perform sporting activities. No difference was seen in intra-operative complications. Femoral hernias should be given high priority for repair and preperitoneal techniques should be used. Earlier diagnosis, in the elective setting, is probably difficult to attain. Heightened awareness in the emergency department is required. TEP is safe, and results in less pain than LLA six weeks after surgery. A widening of indications for TEP in primary inguinal hernia repair is justifiable.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Objective: To assess the occurrence of surgical wound infection (SWI) and other postoperative complications in two groups of patients, with and without antimicrobial prophylaxis, who underwent Lichtenstein inguinal hernioplasty. Design of Study: Clinical study. Place and Period of Study: Department of Surgery, Federal University of Sergipe, from March 2008 to October 2009. Patient and Methods: A total of 80 patients with inguinal hernia were included in the study. All patients underwent Lichtenstein inguinal hernioplasty: 40 with (group A) and 40 without (group B) antimicrobial prophylaxis. Polipropilene mesh was used in all cases. Results: There was no difference in occurrence of SWI between the groups. However, two patients of group B developed postoperative complications, such as hematoma and seroma. Conclusion: There was no difference in SWI frequency between patients with antimicrobial prophylaxis and patients without it. In this study, were observed a low rate of complications (2,53%). / Objetivo: Avaliar a freqüência de infecção do sítio cirúrgico (ISC) e complicações pós-operatórias em dois grupos de pacientes, com e sem profilaxia antimicrobiana, que foram submetidos à hernioplastia inguinal pela técnica de Lichtenstein. Desenho do estudo: Ensaio clínico prospectivo. Local e Duração: Hospital Universitário, Universidade Federal de Sergipe, de março de 2008 a outubro de 2009. Pacientes e Métodos: Foram incluídos no estudo um total de 80 pacientes com hérnia inguinal primária. Todos os pacientes foram submetidos ao reparo de Lichtenstein: 40 com (grupo A) e 40 sem (grupo B) profilaxia antimicrobiana. Em todos os casos foi utilizada tela de polipropileno. Resultados: Não houve diferença entre os grupos em relação à ocorrência de ISC. Contudo, dois pacientes do grupo B desenvolveram complicações pós-operatórias: hematoma e seroma. Conclusão: Não houve diferença na freqüência de ISC entre os pacientes que usaram e aqueles que não usaram profilaxia antimicrobiana. A taxa de complicações foi de (2,53%).

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-08-16T11:58:32Z No. of bitstreams: 1 gabrielacoelimenezesevangelista.pdf: 2720259 bytes, checksum: e0fbd85772c3ba4fa8fdd3c1ee5c09b0 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-16T11:59:14Z (GMT) No. of bitstreams: 1 gabrielacoelimenezesevangelista.pdf: 2720259 bytes, checksum: e0fbd85772c3ba4fa8fdd3c1ee5c09b0 (MD5) / Made available in DSpace on 2017-08-16T11:59:14Z (GMT). No. of bitstreams: 1 gabrielacoelimenezesevangelista.pdf: 2720259 bytes, checksum: e0fbd85772c3ba4fa8fdd3c1ee5c09b0 (MD5) Previous issue date: 2018-02-15 / CNPq - Conselho Nacional de Desenvolvimento Científico e Tecnológico / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Atualmente a obesidade é um problema de saúde pública, que afetar todas as idades, classes sociais e regiões do planeta. Segundo dados da OMS de 2016, 13% da população adulta é considerada obesa. No Brasil 12,4% dos homens e 16,9% das mulheres acima de 18 anos foram considerados obesos, em 2011, pelo Ministério da Saúde. O câncer de mama é o único câncer diagnosticado em todas as regiões do planeta e, segundo a Sociedade Americana de Câncer, em 2012, o câncer de mama foi responsável por 25% dos novos casos e matou mais de meio milhão de mulheres. As brasileiras também sofrem com o tumor de mama que é o mais diagnosticado no Brasil, segundo dados de 2016 do INCA. A obesidade duplica a chance de desenvolver câncer de mama e isso está relacionado à inflamação crônica de baixo grau instaurada pelo acúmulo de gordura que recruta células inflamatórias secretoras de citocinas, quimiocinas e fatores de crescimento, aumentando a inflamação. Nesse contexto as células mamárias malignas se apropriam dessa inflamação e seus mediadores para promover sua sobrevivência, proliferação, disseminação e metástase. Para identificarmos o papel da obesidade no tumor mamário, utilizamos o modelo experimental de câncer de mama murino 4T1 em animais Balb/c fêmeas alimentadas por 16 semanas com dieta padrão ou dieta hiperlipídica (60% das quilocalorias são lipídeos). Cada animal foi pesado semanalmente e o consumo médio diario de ração foi calculado. Ao final das 16 semanas mais os 21 dias de injeção do tumor, os animais foram eutanasiados para a quantificação do peso das gorduras perigonadais e retroperitoniais e remoção dos linfonodos inguinais drenantes do tumor para realização da citometria de fluxo. Os resultados indicaram que os animais alimentados com HFD, ganharam mais peso mesmo consumindo menos ração em relação, aos animais alimentados com dieta padrão. Esse ganho de peso refletiu em uma maior adiposidade nos obesos, devido ao maior peso das gorduras perigonadais e retroperitoniais. Além disso, os animais obesos apresentaram um maior Índide de Lee em relação aos controles. Nosso trabalho indicou uma queda generalizada da resposta imune contra tumor, pois observamos uma diminuição no número de células totais dos linfonodos drenantes do tumor, refletindo num menor número de células dendríticas e macrófagos, que apresentaram menor ativação com baixas expressões dos co-estimuladores CD80 e CD86; e numa redução da resposta adaptativa, tanto no número de células efetoras como linfócitos auxiliares e citotóxicos quanto no número de células reguladoras como os linfócitos Breg e Treg. Além disso, também observamos um desbalanço entre a citocina inflamatória IFN-γ e a citocina anti-inflamatória IL-10, produzidas por linfócitos CD4+ e CD8+. Em conjunto, nossos dados nos permitem concluir que a obesidade afeta diretamente o sistema imune através da diminuição da resposta celular contra o tumor como um todo, essa regulação pode ser devido a modulação da hematopoiese e indução de células MDSC. / Nowadays the obesity is a public health issue capable to affect all ages, social classes, and regions of the globe. According to data from Word Health Organization in 2014, 13% of the adult population is considered obese. In Brazil the number are also startling: in the adult population 12.4% of the men and 16.9% of women already was considered obese in 2011 by Ministry of Healthy. Breast cancer is the only one diagnosed in all regions of the planet and, according to American Society of Cancer, in 2012 this type of cancer was responsible for 25% of the new cases and killed more than half millions of women. The Brazilian women undergo by breast cancer, which is the most commonly diagnosed among Brazilian women, according data from Nacional Institute of Cancer in 2015. Is certain that the obesity duplicates the chances to develop breast cancer and it is correlated to the low grade chronic inflammation established by the fat accumulation which recruit inflammatory cells that secrete cytokine, chemokines, and growth factors, increasing the inflammation. In this context the malignant mammalian cells get hold of this inflammation and its mediators to promote its own survival, proliferation, dissemination, and metastasis. To identify the role of the obesity in malignant breast tumor, we utilized in this project the experimental murine model of breast cancer 4T1 in animals Balb/c females feed for 16 weeks with the pattern diet or high-fat diet which 60% of kilocalories coming from lipids. Each animal was weekly weighed and the individual average intake was calculated. At the end of the 16 weeks more 21 tumor days after injection, the animals were euthanized for removal of the perigonadal and retroperitoneal fat-pad and also for the removal of the draining inguinal lymph nodes of the tumor to flow cytometry analysis. The results indicate that the animals feed with HFD, had weight gain even eating less than the animals feed by control diet. This gain reflected in a major adiposity in obese animals due to higher weight of the perigonadal and retroperitoneal fat-pad. Moreover, the obese animals had a higher Lee Index on comparison of the controls animals. Our work indicated a general decrease in the immune response against the tumor because was observed a decay of the number of the total cells of the tumor lymph nodes drainage, which reflected a low number of macrophages and dendritic cells, which also presents a lower activation with low expression of co-stimulators CD80 and CD86; and a decrease in the number of cells from adaptive response effector and in regulator cells like lymphocytes Breg and Treg. In addition, was also observed an unbalancing between the inflammatory cytokine IFNv and the anti-inflammatory cytokine IL-10, produced by lymphocytes CD4+ and CD8+. Together, this data allowed us to conclude that the obesity directly affect the immune system through the reduction of the cellular response against the tumor, this setting can be due to modulation of hematopoiesis and induction of MDSC.

<p>UVOD: Ingvinalna hernioplastika predstavlja najučestaliju operaciju u abdominalnoj hirurgiji. U istorijatu herniologije su se razvijale različite ideje, te iz njih nastale operativne metode, koje su imale za cilj formiranje kvalitetnog vezivnog tkiva na mestu kilnog defekta. Danas postoje brojne hirur&scaron;ke tehnike, bazirane na tenzionim ili beztenzionim principima, uz primenu hirur&scaron;kih mrežica, otvorenim pristupom, kao i laparoskopskim tehnikama. Zajednički cilj navedenih metoda je kreiranja idealne hernioplastike ingvinalnih kila. I pored postojanja ogromnog broja hirur&scaron;kih procedura i tehnika, jo&scaron; uvek ne postoji tzv. &raquo;prava hernioplastika&laquo; koja bi zadovoljila sve potrebne zahteve vezane za problem ingvinalnih hernija. CILJ I HIPOTEZA: Cilj rada je bio da se napravi uporedna analiza između dve različite hirur&scaron;ke tehnike otvorenim pristupom, konvencionalne tenzione suturne hernioplastike, te beztenzione tehnike, uz kori&scaron;ćenje hirur&scaron;kih mrežica ( mesh ). Kori&scaron;ćeni su sledeći parametri tokom istraživanja: određivanje nivoa postoperativnog bola prema numeričkoj skali, vizuelno-analognoj te kategorijskoj skali bola; određivanje samostalne fizičke aktivnosti; (savijanje nogu, naprezanje trbu&scaron;nih mi&scaron;ića, ustajanje) u neposrednom postoperativnom periodu; gradacija nivoa mi&scaron;ićne snage, određivanje vremenskog perioda kada se pacijenti uspevaju vratiti svojim svakodnevnim aktivnostima i radnim obavezama; određivanje stope postoperativnog morbiditeta i mortaliteta te određivanje stope ranog recidiva bolesti. RADNA HIPOTEZA: Beztenzionu ingvinalnu hernioplastiku karakteri&scaron;e znatno manja operativna trauma, &scaron;to ima za posledicu manji lokalni i generalizovani odgovor organizma na stres. Kod bolesnika operisanih beztenzionom metodom očekuje se manji intenzitet bola, kraće zadržavanje u hospitalnim uslovima, manji procenat postoperativnih komplikacija, brži povratak uobičajenim fizičkim i radnim aktivnostima i znatno manji stepen recidiva bolesti. Pretpostavlja se da beztenziona ingvinalna hernioplastika u poređenju sa konvencionalnom uzrokuje manju nelagodnost za pacijente, znatno manji postoperativni bol i bolju mi&scaron;ićnu aktivnost. Pobolj&scaron;anje mi&scaron;ićne aktivnosti ogleda se u lak&scaron;oj vertikalizaciji, kvalitetnijem kretanju uz manje bolan hod, bez povijanja tela na stranu operativne rane. MATERIJAL I METODE: Istraživanje je prospektivna, kliničko- statistička studija sa praćenjem parametara (preoperativnih, intraoperativnih i postoperativnih) kod svakog operisanog bolesnika. Studija je obuhvatila seriju od 200 pacijenata hospitalizovanih na Klinici za abdominalnu, endokrinu i transplantacionu hirurgiju Kliničkog centra Vojvodine, od decembra 2002. do avgusta 2007.godine, svrstanih u dve jednake grupe po 100 pacijenata, odabranih metodom slučajnog izbora. Prva, ispitivana grupa obuhvatila je pacijente operisane beztenzionim procedurama, druga, kontrolna grupa je obuhvatila pacijente operisane konvencionalnim, tenzionim tehnikama. Kori&scaron;ćeni metod rada je kliničko statistički sa praćenjem svih potrebnih fiziolo&scaron;kih parametara, a dobijeni rezultati su analizirani i međusobno upoređivani statističkim metodama multifaktorijalne analize. Pronađene vrednosti su međusobno upoređene parametrijskim i neparametrijskim testovima značajnosti na nivou p&lt;0.05. REZULTATI: komparacija između dve ispitivane grupe je vr&scaron;ena tokom preoperativnog, intraoperativnog i postoperativnog perioda, različitim statističkim parametrima. Konstatovana je, statističkom analizom, homogenost grupa u smislu starosne dobi i polne distribucije, kao i lokalnog preoperativnog nalaza vezanog za tip, veličinu i lokalizaciju kila, kao i spram klasifikacije hernija. U sledećim parametrima je ustanovljena statistički signifikantna razlika: postoperativni bol, gradacija mi&scaron;ićne snage, rana fizička aktivnost, količina utro&scaron;enih analgetika, dužina hospitalizacije, prisutnost obostranih kila, povratak radnim aktivnostima i obavezama, postoperativne komplikacije i recidiv bolesti. Dobijeni podaci su prikazani tabelarno, te delom u vidu grafikona i dijagrama. ZAKLJUČCI: 1. Kod pacijenata operisanih beztenzionom metodom evidentan je znatno manji postoperativni bol i brži oporavak i povratak uobičajnim dnevnim i radnim aktivnostima 2. Proceduru treba izvoditi u svim slučajevima sa prisutnim velikim defektima i razorenim zadnjim zidom ingvinalnog kanala 3 Beztenzionu hernioplastiku karakteri&scaron;e manji broj recidiva u poređenju sa otvorenim tenzionim hernioplastikama. 4. Pacijenti sa bilateralnim ingvinalnim i recidivnim hernijama imaju punu indikaciju za izvođenje beztenzione herioplastike sa ugradnjom mesh-a. 5. Preduslov za uspe&scaron;no obavljenu beztenzionu hernioplastiku je primena dovoljno velike proteze, odnosno mesh-a, dimenzija 15 x 10 cm.</p> / <p>INTRODUCTION: Inguinal hernioplasty is the most common surgical procedure in abdominal surgery. In the history of herniology have developed different ideas, and from them emerged operational methods, which are aimed at educating quality of connective tissue at the site of the hernia defect. Nowadays, there are numerous surgical techniques, based on the tensioned or tension-free principles, with the use of surgical mesh for open access as well as laparoscopic techniques. Common goal of these methods is creating ideal inguinal hernioplasty despite the existence of a huge number of surgical procedures and techniques, there is still no so-called &raquo;Proper hernioplasty &quot; that would satisfy all the necessary requirements related to the problem of inguinal hernia. AIM AND HYPOTHESIS: The aim of this study was to make a comparative analysis between two different open access surgical techniques conventional tension hernioplasty and tension-free techniques, with the use of surgical mesh .The following parameters were used during the research: determining the level of postoperative pain according to a numerical scale, visual analogue scale and categorical scale of pain; determining the initial independent physical activities: (bending the legs, straining abdominal muscles, getting up) in the immediate postoperative period; gradation levels of muscular strength, determination period when patients can return to their usual daily activities and work duties; determining the rate of postoperative morbidity and mortality and to determine rates of early recurrence of the disease. WORKING HYPOTHESIS: Tension-free inguinal hernioplasty characterized by significantly less operative trauma, which results in smaller local and generalized body&#39;s response to stress. In patients operated by the tension. free method is expected to lower the intensity of pain, a shorter stay in the hospital setting, a smaller percentage of postoperative complications, faster return to normal physical and occupational activities and much lower degree of disease recurrence. It is assumed that the tensional. free inguinal hernioplasty compared with conventional causes less discomfort for patients, significantly less postoperative pain and better muscle activity. Better muscle activity is reflected in a facilitated mobilization, quality of movement and less painful gait, without bending the body at the side of the surgical wound. MATHERIAL AND METHODS: The research was a prospective, clinical-statistical study of the monitoring parameters (preoperative, intraoperative and postoperative) in each of the operated patients. The study involved a series of 200 patients hospitalized at the Clinic for Abdominal, Endocrine and Transplantation Surgery, Clinical Center Vojvodine, from December 2002 to August 2007, divided into two groups of 100 patients, randomly chosen. First, the test group consisted of patients operated by the tension-free procedures, the other, the control group consisted of patients operated on conventional techniques. The method used is the work of clinical statistical tracking of all necessary physiological parameters, and the results were analyzed and compared with each other with multivariate statistical methods of analysis. Found values are compared with each other parametric and non-parametric tests of significance at p &lt;0.05. RESULTS: The comparison between the two study groups was performed during the preoperative, intraoperative and postoperative period, using various statistical parameters. It was noted using the statistical analysis, the homogenity of the groups in terms of age and sex distribution, as well as local preoperative findings related to the type, size and location pounds as well as towards the classification of hernias. In the following parameters is statistically significant difference: postoperative pain, graduations of muscle strength, healing of physical activity, the quantity of analgesics, length of hospitalization, the presence of bilateral hernias, the return of work activities and responsibilities, postoperative complications and recurrence. The data are presented in tables, and partly in the form of graphs and charts. CONCLUSIONS: 1. In patients operated by the tension-free obvious method is significantly less postoperative pain and faster recovery and return to usual daily and work activities 2. The procedure should be performed in all cases with the presence of large defects and lacerated back wall of the inguinal canal 3. Tension-free hernioplasty is characterized by a smaller number of recurrence compared with conventional hernioplasty 4. Patients with bilateral inguinal hernias and recurrent have a full indication of the performance of the tension-free hernioplasty with the installation of mesh. 5. A prerequisite for the successful work carried out tension-free hernioplasty application is large enough prosthesis ( mesh ), measuring 15 x 10 cm.</p>

In einer prospektiv-randomisierten klinischen Studie zur Leistenhernienreparation wurde die konventionelle Shouldice Operation mit den spannungsfreien Verfahren durch Netzimplantation in endoskopischer (transabdominelle praeperitoneale Netzplastik, TAPP) und offener Technik (Plug und Patch Reparation; PP) verglichen. Bezogen auf das Hauptzielkriterium postoperative Schmerzen ergaben beide spannungsfreie Verfahren (TAPP, PP) signifikant guenstigere Ergebnisse als die Shouldice Operation. Bei vergleichbarer Komplikationsrate war die Dauer postoperativer Einschraenkungen bei den spannungsfreien Verfahren ebenfalls signifikant kuerzer als nach Shouldice Operation. Zur Verbesserung der fuer die spannungsfreie Reparation erforderlichen Netzimplantate wurde in einer Tierstudie versucht, die bislang durch Resorption ungenuegende mechanische Stabilitaet eines resorbierbaren Polyglycolsaeure-Netzes durch Zugabe von Fibrinkleber bzw. humanen thrombozytaeren Wachstumsfaktoren zu verbessern. Hierdurch gelang ein signifikanter Anstieg der mechanischen Stabilitaet, so daß in dem verwendeten Tiermodell keine Herniationen auftraten. / In a prospective-randomized study conventional Shouldice operation was compared with tension-free procedures using mesh implantation in endoscopic (transabdominal preperitoneal mesh repair, TAPP) and open technique (Plug and patch repair; PP) for inguinal hernia repair. Regarding the mean end point postoperative pain both tension-free procedures (TAPP, PP) revealed significantly better results than Shouldice operation. Complications were comparable between the groups but duration of postoperative restrictions was significantly shorter after both tension-free procedures. To improve mesh quality for tension-free hernia repair an animal experiment was performed using a resorbable polyglycolic acid mesh. Despite good incorporation this mesh shows insufficient tensile strength due to absorption. Application of fibrin glue or platelet releasates significantly improve the mechanical stability of the repair protecting against herniation in this animal model.

The sciatic nerve is the largest nerve in the human body giving both motor and sensory innervations to the lower limb. It can be affected in chronic diseases, such as diabetes, or compressed anatomically by structures such as piriformis and aneurysms leading to sciatica or paralysis of the lower limb. The current study therefore focuses on the arterial supply of the sciatic nerve as well as its course. Embryologically, the sciatic nerve is supplied via the axial artery during the first trimester. As the axial artery regresses, the iliac system develops. A failure of sciatic artery regression leads to several variations of pelvic and femoral arteries, with a risk of iatrogenic injury/trauma for those patients undergoing pelvic, gluteal and thigh surgical procedures. An understanding of the variability of the pelvic arteries in relation to a coexistent sciatic artery will provide an appropriate background for clinicians. The present study proposes a new theory of sciatic artery development and persistence, as well as new theories for the superior and inferior gluteal, internal pudendal and obturator arteries. The thesis is in two parts: first an anatomical study on the dissection of 171 cadavers including the pelvic, gluteal and thigh regions to observe (i) the patterns of the arteries these regions, and (ii) the course of the sciatic nerve. With variable course of sciatic nerve, there is a variability of its blood supply. Moreover, it includes a new classification of sciatic nerve with respect to clinical implications. The thesis clarifies the origins of the sciatic artery and its course. The second part is a literature review of sciatic artery aneurysm cases in 171 patients, which clarifies the risk of aneurysm, together with its incidence with respect to pathologic finding and associated disorders. Radiologists have to be aware of the internal iliac artery classifications to be able to alert general surgeons, orthopaedic surgeons, obstetricians, gynecologists, and urologists so that they can improve patient management.

No description available.

Quality-of-life and functional outcomes are important in the choice of treatment for men with localized prostate cancer. These issues were investigated in the present thesis. All living 400 men randomized to radical prostatectomy or watchful waiting from 1989 to 1999 in the Scandinavian Prostate Cancer Group Number 4 (SPCG-4) were included. An additional 281 men compromised an age-matched control group. Physical symptoms, symptom-induced stress, sense of well-being and self-assessed quality of life were evaluated by a study-specific questionnaire. Results showed that prostate cancer men, regardless if they were allocated to radical prostatectomy or watchful waiting were suffering of long term adverse effects, mainly erectile dysfunction, urinary leakage and voiding symptoms. In the prostatectomy group, erectile dysfunction and urinary leakage were often consequences of surgery; in the watchful waiting group the side-effects could be caused by tumor progression. The quality of life deteriorated over time. High self-assessed quality of life was reported by 35 % in the radical, 34 % in watchful-waiting, and 43 % in the control groups after a median follow-up time of 12.2 years. The SPCG-4 men significantly more often reported anxiety than did controls. Erectile dysfunction was associated with the most negative influence on quality of life in both SPCG-4 groups. Men in the prostatectomy group were more distressed by erectile dysfunction than watchful waiting. Androgen deprivation therapy had negative effects on all psychological parameters, including quality of life, for the watchful waiting but not for the prostatectomy group. Information about the prostate-cancer disease was significantly higher in the radical-prostatectomy group than in watchful waiting. Check-ups were associated with worry, especially for those on androgen deprivation therapy. Open radical prostatectomy led to an increased rate of inguinal hernia compared with robot-assisted technique. In conclusion, the data of this thesis emphasize that it takes more than a decade to understand the patterns of adverse effects and time dimension of their occurrence for each treatment. Consideration of quality of life has a high priority to aid the ageing man through the shifting scenarios of localized prostate cancer.

Introduction: Transabdominal laparoscopic (TAPP) approach in the therapy of inguinal hernia is a suitable alternative to classical open inguinal hernia repair mainly in the hands of an experienced surgeon. TAPP repair offers the possibility of gentle dissection with implantation of the mesh from posterior approach. Hypothesis and objectives of the work: The fixation of mesh through penetrating techniques using staples, clips or screws is associated with a significantly increased risk of developing a post-herniotomy inguinal pain syndrome (CPIP). The aim of the thesis is to review options of self-fixating meshes in laparoscopic TAPP procedure without additional fixation. Furthermore to evaluate effect of this technique on development of the chronic postoperative groin pain and also on frequency of hernia recurrence and mesh migration. Patients and methods: Data analysis included all patients, who underwent inguinal hernia surgery at our Surgical Department within the period from 1.10.12 to 31.12.14 and fulfilled the inclusion criteria. Standard surgical technique was used. Data were entered and subsequently analyzed on Herniamed platform. Results: There were 241 patients enrolled to the group of which 396 inguinal hernias were repaired. The minimal follow up was at 12 months. At the assessment in one...

Various surgical techniques for the repair of injured vas deferens in rat experiment Introduction: The herniotomy for inguinal hernia is one of the most frequent surgical procedures in paediatric surgery. The incidence of complication following primary inguinal herniotomy in neonates is not rare and repair of the injured vas deferens (VD) is not standardized. The aim of this experimental study was to assess the contusion of VD during the surgery with a surgical instrument and to perform and consequently analyze some possibilities of a simple repair method under the control of operating loupe. Methods: Seventy male rats were divided into seven subgroups according to the type of the vas deferens injury and its repair consequently: 1. Contusion, 2. cut-off and a simple one layer vasovasostomy sewn by absorbable sewing material, 3. cut-off and joining by an intraluminally lead fibre of absorbable sewing material knotted externally, 4. = 3. using non- absorbable sewing material, 5. = 2. combine with intraluminally situated absorbable sewing fibre fixed externally,6. = 5. combine with intraluminally situated non-absorbable sewing fibre fixed externally, 7. = 5. without external fixation. Fibres of non-absorbable sewing material were removed 3 weeks after the first operation. Operated or injured parts of...