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...

Degaardt, M & Rubensson, M. Postoperativt förlopp efter dagkirurgiskljumskbråcksoperation. Uppföljningssamtal som grund för kvalitetsutveckling.Examensarbete i omvårdnad 15 högskolepoäng. Malmö högskola: Hälsa ochsamhälle, Utbildningsområde omvårdnad, 2010.Syftet med denna studie var att göra en bedömning av den postoperativa förloppeti hemmet hos dagkirurgiska ljumskbråcksopererade patienter. Data insamlademed hjälp av högstrukturerade telefonintervjuer. En enkät med standardiseradefrågor och ikryssbara svarsalternativ som kommer har använts vidtelefonintervjuerna. Resultaten från de 52 intervjuerna visade att de flestapatienter inte överskred Numerical Rating Scale (NRS) 3 i vila eller rörelse dagett. På dag tre hade de flesta mer smärta vid rörelse än dag ett. De flestapatienterna följde ordinationen de fick av läkaren avseende smärtstillandetabletter. Generellt sett visade studien på få postoperativa komplikationer och högtillfredsställelse ur operationssynpunkt hos patienterna. / Degaardt, M. & Rubensson, M. Post-operative progress after one-day surgicalinguinal hernia operation. Follow-up interviews as a means for qualitydevelopment. Degree project in nursing, 15 credit points. Malmö University:Faculty of health and society, Department of nursing, 2010.The purpose of this study was to evaluate the post-operative progress for one-daysurgical inguinal hernia patients. Data was collected using structured telephoneinterviews three days after surgery. A questionnaire with standardized questionsand multiple-choice response opions was used. The results from the 52 interviewsshowed that most patients did not exceed Numerical Rating Scale (NRS) 3 dayone when at rest or moving around. On day three most patients had more painwhile moving than day 1. Most patients complied with the doctor’s prescription ofpainkillers. Generally the follow-up study showed the patients had fewcomplications and felt high satisfaction post surgery.

Einleitung: Die Diagnostik und Behandlung des Kryptorchismus stellt in der Pferdemedizin ein häufig vorkommendes Aufgabenfeld dar. Sowohl für die Diagnostik als auch für die Therapie existieren unterschiedliche Methoden, die in der Literatur kontrovers diskutiert werden. Studien, in denen Diagnostik und Therapie gemeinsam untersucht wurden, existieren bisher nicht. Bei der Auswahl der Methoden sollte Berücksichtigung finden, dass diese komplikationsarm sind, einen angemessenen Kosten-Nutzen-Aufwand bedingen und dass die vollständige Kastration nur einer Operation bedarf. Zur Vermeidung von Zweitoperationen oder der Konversion der Operationstechnik ist eine exakte präoperative Diagnostik notwendig. Ziele der Untersuchung: Das Ziel der Studie ist die wissenschaftliche Aufarbeitung der in der Klinik für Pferde der Veterinärmedizinischen Fakultät der Universität Leipzig vorgestellten Kryptorchiden hinsichtlich Diagnostik und Therapie. Dabei wurden folgende Hypothesen geprüft: 1. Unter Nutzung der transkutanen sonographischen Untersuchung ist eine verlässliche Lokalisation maldescenter Hoden möglich und 2. Die laparoskopische Kryptorchektomie unter Allgemeinanästhesie ist eine sichere Methode zur Entfernung abdominaler Hoden und hinsichtlich der Morbidität vergleichbar mit der Entfernung inguinaler Hoden auf konventionellem Weg. Tiere, Material und Methoden: In einer retrospektiven Studie wurden die Patientendaten von Tieren, die in den Jahren 2008 bis 2019 zur Kryptorchektomie vorgestellt wurden, ausgewertet. In die Untersuchungen wurden folgende Daten einbezogen: Signalement, Vorbericht, Befunde der palpatorischen, rektalen und sonographischen Untersuchung. Die sonographischen Untersuchungen fanden mit einem für die rektale Untersuchung verwendbaren Linearschallkopf (7,5 MHz) statt. Weiterhin wurden die Ergebnisse der Hormonuntersuchung, Lokalisation der entfernten Hoden, Chirurg, chirurgische Technik, Dauer der Chirurgie, Erfolg des operativen Eingriffes, Ergebnis der histologischen Untersuchung, perioperative Gabe von Medikamenten, intraoperative und postoperative Komplikationen, Dauer und Kosten des Klinikaufenthaltes sowie Spätkomplikationen betrachtet. Die statistische Auswertung erfolgte mittels Mathematica (Version 12.0, Wolfram Research Inc., Champaign, IL, USA). Die Überprüfung der Daten auf Normalverteilung erfolgte mit dem Shapiro-Wilk-Test. Gruppenvergleiche erfolgten mittels Mann-Whitney-Test. Es wurden Vierfeldertafeln erstellt und Sensitivität, Spezifität, Positiver und Negativer Vorhersagewert sowie die zugehörigen 95 %-Konfidenzintervalle berechnet. Zusammenhänge von dichotomen Variablen wurden mit dem Fisher`s exaktem Test, Häufigkeiten mittels Fisher`s exaktem Test für 1 x 2 Tabellen untersucht. Das Signifikanzniveau für alle Tests wurde mit p <0,05 festgelegt. Ergebnisse: 86 Pferde erfüllten die formulierten Einschlusskriterien. Unter den Rassen war das Deutsche Sportpferd mit 32 Tieren am häufigsten vertreten, was der Verteilung der Klinikpopulation entspricht. Neben weiteren Großpferderassen wurden auch drei Shetlandponys sowie zwei Esel in die Studie eingeschlossen. Das Alter der Tiere betrug im Median 2 Jahre und das Gewicht der Tiere im Durchschnitt 414,76 kg. Die Mehrzahl der Pferde (73/86; 84,9 %) wurde als Kryptorchiden ohne Voroperation überwiesen. Hormonuntersuchungen fanden in 7 % der Fälle statt. Die rektale Untersuchung wurde lediglich bei 3,5 % der Tiere vorgenommen und führte zu unklaren Ergebnissen. Bei allen Pferden erfolgte eine transkutane sonographische Untersuchung. Die sonographische Untersuchung war bezüglich inguinaler Hoden deutlich sensitiver als die palpatorische Untersuchung (97,96 % vs. 61,22 %). Die Diagnose abdominaler Kryptorchismus wurde gestellt, wenn der Hoden im Abdomen mittels transkutaner Sonographie auffindbar war oder wenn er inguinal nicht darstellbar war und keine Operationsnarbe vorlag. Auf diese Weise konnte bei 97,6 % der Tiere eine korrekte präoperative Diagnose gestellt und das geeignete operative Verfahren bestimmt werden. Bei Außerachtlassung der Shetlandponys und Esel wurde zu 100 % eine richtige präoperative Diagnose gestellt. Die operative Diagnose war in 36 Fällen ein abdominaler und in 49 Fällen ein inguinaler Kryptorchismus. Bei einem Pferd wurde die Diagnose Monorchismus gestellt. Insgesamt wurden an den 86 Pferden 89 chirurgische Eingriffe für die vollständige Kryptorchektomie oder die abschließende Diagnosestellung vorgenommen. Beim inguinalen Kryptorchismus erfolgte der chirurgische Zugang über einen Schnitt im Bereich des äußeren Leistenringes. Die abdominalen Hoden wurden auf laparoskopischem Weg entfernt, wobei die Operation bei 37 Tieren unter Allgemeinanästhesie und bei einem Pferd im Stehen vorgenommen wurde. Die Operationszeiten betrugen im Median beim inguinalen Kryptorchismus 17 Minuten (IQR = 5) und beim abdominalen Kryptorchismus 30 Minuten (IQR = 10). Der Unterschied der Operationszeiten war signifikant (p ≤ 0,001). Die Zahl der Komplikationen betrug bei den Minor-Komplikationen 15,1 % und bei den Major-Komplikationen 1,2 %. Kein Pferd verstarb oder musste euthanasiert werden. Zwei Pferde mussten nach dem Klinikaufenthalt weiter tierärztlich behandelt werden. Es bestand kein signifikanter Unterschied bei den Komplikationen zwischen der Kryptorchektomie von inguinalen und abdominalen Hoden. Die Dauer des postoperativen stationären Klinikaufenthaltes war für die Tiere mit inguinalem Kryptorchismus signifikant (p = 0,002) kürzer. Pferde mit inguinalem Kryptorchismus verblieben im Median 2 Tage (IQR = 1) und Tiere mit abdominalem Kryptorchismus 3 Tage (IQR = 1) stationär in der Klinik. Schlussfolgerungen: Mit Hilfe der transkutanen sonographischen Untersuchung ist eine verlässliche Lokalisation maldescenter Hoden möglich. Die Notwendigkeit von Zweitoperationen oder die Konversionen der Operationstechnik ist bei der beschriebenen präoperativen Diagnostik mit den daraus bedingten chirurgischen Zugängen zufriedenstellend gering. Die laparoskopische Kryptorchektomie unter Allgemeinanästhesie stellt ein sicheres risikoarmes Verfahren zur Behandlung des abdominalen Kryptorchismus dar.

No presente estudo, 30 pacientes, do sexo masculino com idade mediana de 29 anos, portadores de hérnias inguinais / inguino-escrotais, unilaterais, indiretas e primárias, sem encarceramento ou estrangulamento, foram submetidos à hernioplastia inguinal, por meio de inguinotomia, sob raqui-anestesia em regime de internação hospitalar. A técnica de correção utilizada foi a de Bassini modificada, sendo que estas modificações repousam no tipo da incisão, abordagem da fáscia transversalis e no reforço da parede posterior do canal inguinal. Os objetivos foram os de avaliar os resultados do pós-operatório mediato quanto aos eventos: intensidade e duração da dor pós-operatória e o tempo de retorno às atividades normais, estabelecendo assim a duração maior ou menor do período de convalescença. Das hérnias operadas 33,33% e 66,67% foram classificadas no intra-operatório como tipos I e II de Nyhus, respectivamente. A duração da cirurgia variou entre 45 e 85 minutos, com média de 66,46 minutos e mediana de 66,5 minutos. A permanência hospitalar foi menor que 24 horas. O índice de mortalidade foi nulo e o seguimento foi feito no 10º e 30° dias de pós-operatório. A intensidade média da dor pós-operatória atingiu seu pico máximo no 1º dia, alcançando 2,93 na escala analógica decimal, sendo que a partir do 5° dia de pós-operatório se tornou insignificante. O retorno às atividades habituais e sociais se deu em um período médio de 5,34 dias. O tempo de retorno ao trabalho alcançou a média de 11,23 dias e mediana de 5 dias. Observou-se complicação leve em dois pacientes (6,67%), que apresentaram edema de bolsa escrotal de rápida resolução. Não se observou complicações infecciosas apesar do não uso de antimicrobianos. A análise dos dados obtidos permite concluir que o procedimento é exeqüível, com boa aceitação por parte dos pacientes, apresentando resultados comparáveis aos obtidos na literatura / In the present study, 30 patients, of the male sex, with an average age of 29, victims of inguinal hernias/ inguino-scrotum, unilateral, indirect and primaries, without confinement or strangulation, were submitted to inguinal hernioplasty, thru inguinotomy, under rachianesthesia on a regimen as hospital in--patients. The correction technique used was the modified- Bassini, since these modifications lie in the kind of incision, approaching of the fascia transversalis and in the reinforcement of the posterior wall of the inguinal duct. The purposes were of evaluating the mediate post-operative results as to the events: intensity and duration of the post-operative pain in the period of time of return to the normal activities, thus determining the longer or shorter duration of the recovery period. Among the operated hernias 33.33% and 66.67% they were classified in the intra-operative as types I and II of Nyhus, respectively. The duration of the surgery varied between 45 and 85 minutes, with an average of 66.46 minutes and median of 66.5 minutes. The in-patients stay in the hospital was less than 24 hours. The mortality rate was null and the follow up was made on the 10th and 30th days of the post operative. The average intensity of the post-operative pain reached its appex on the 1st day, reaching 2.93 in the decimal analogical scale, and as of the 5th day of the post-operative it became insignificant. The return both to the usual and social activities happened in an average period of time of 5.34 days. The period of time of returning to work reached an average of 11.23 days and a median of 5 days. A slight complication was observed in two patients (6.67%), who had edema in the scrotum pouch of fast solution. No infectious complications were detected in spite of not using any anti-microbians. The analysis of the data obtained allow to conclude that the procedure is feasible, with good approval on the part of the patients, presenting results comparable to the ones obtained in the literature

No presente estudo, 30 pacientes, do sexo masculino com idade mediana de 29 anos, portadores de hérnias inguinais / inguino-escrotais, unilaterais, indiretas e primárias, sem encarceramento ou estrangulamento, foram submetidos à hernioplastia inguinal, por meio de inguinotomia, sob raqui-anestesia em regime de internação hospitalar. A técnica de correção utilizada foi a de Bassini modificada, sendo que estas modificações repousam no tipo da incisão, abordagem da fáscia transversalis e no reforço da parede posterior do canal inguinal. Os objetivos foram os de avaliar os resultados do pós-operatório mediato quanto aos eventos: intensidade e duração da dor pós-operatória e o tempo de retorno às atividades normais, estabelecendo assim a duração maior ou menor do período de convalescença. Das hérnias operadas 33,33% e 66,67% foram classificadas no intra-operatório como tipos I e II de Nyhus, respectivamente. A duração da cirurgia variou entre 45 e 85 minutos, com média de 66,46 minutos e mediana de 66,5 minutos. A permanência hospitalar foi menor que 24 horas. O índice de mortalidade foi nulo e o seguimento foi feito no 10º e 30° dias de pós-operatório. A intensidade média da dor pós-operatória atingiu seu pico máximo no 1º dia, alcançando 2,93 na escala analógica decimal, sendo que a partir do 5° dia de pós-operatório se tornou insignificante. O retorno às atividades habituais e sociais se deu em um período médio de 5,34 dias. O tempo de retorno ao trabalho alcançou a média de 11,23 dias e mediana de 5 dias. Observou-se complicação leve em dois pacientes (6,67%), que apresentaram edema de bolsa escrotal de rápida resolução. Não se observou complicações infecciosas apesar do não uso de antimicrobianos. A análise dos dados obtidos permite concluir que o procedimento é exeqüível, com boa aceitação por parte dos pacientes, apresentando resultados comparáveis aos obtidos na literatura / In the present study, 30 patients, of the male sex, with an average age of 29, victims of inguinal hernias/ inguino-scrotum, unilateral, indirect and primaries, without confinement or strangulation, were submitted to inguinal hernioplasty, thru inguinotomy, under rachianesthesia on a regimen as hospital in--patients. The correction technique used was the modified- Bassini, since these modifications lie in the kind of incision, approaching of the fascia transversalis and in the reinforcement of the posterior wall of the inguinal duct. The purposes were of evaluating the mediate post-operative results as to the events: intensity and duration of the post-operative pain in the period of time of return to the normal activities, thus determining the longer or shorter duration of the recovery period. Among the operated hernias 33.33% and 66.67% they were classified in the intra-operative as types I and II of Nyhus, respectively. The duration of the surgery varied between 45 and 85 minutes, with an average of 66.46 minutes and median of 66.5 minutes. The in-patients stay in the hospital was less than 24 hours. The mortality rate was null and the follow up was made on the 10th and 30th days of the post operative. The average intensity of the post-operative pain reached its appex on the 1st day, reaching 2.93 in the decimal analogical scale, and as of the 5th day of the post-operative it became insignificant. The return both to the usual and social activities happened in an average period of time of 5.34 days. The period of time of returning to work reached an average of 11.23 days and a median of 5 days. A slight complication was observed in two patients (6.67%), who had edema in the scrotum pouch of fast solution. No infectious complications were detected in spite of not using any anti-microbians. The analysis of the data obtained allow to conclude that the procedure is feasible, with good approval on the part of the patients, presenting results comparable to the ones obtained in the literature

En chirurgie vasculaire, l’accès à l’artère fémorale, qu’il soit par une incision chirurgicale ou par une approche percutanée, est très fréquemment utilisé pour une multitude d’interventions vasculaires ou endovasculaires; pour des pontages divers, le traitement d’occlusions artérielles, la réparation d’anévrismes et la pose d’endoprothèses. L’objectif général de ce projet de recherche est de faciliter et réduire les risques des approches de l’artère fémorale par une meilleure compréhension anatomique du triangle fémoral. La méthodologie a été réalisée grâce à l’utilisation de cadavres spécialement embaumés par la méthode développée par Walter Thiel. Les résultats présentés dans ce mémoire ont permis de proposer des solutions en réponse à des problèmes cliniques en chirurgie vasculaire. Dans un premier temps, l’étude de la vascularisation cutanée du triangle fémoral a mené à proposer de nouvelles incisions chirurgicales afin de limiter la dévascularisation cutanée des plaies et ainsi réduire les problèmes de cicatrisation observés. Ensuite, nous avons validé l’identification radiographique et échographique de l’artère fémorale à son croisement avec le ligament inguinal afin de faciliter l’identification d’un site de ponction artérielle adéquat. Enfin, nous avons développé une méthode échographique simple qui facilite l’approche percutanée de l’artère fémorale, même chez les patients obèses. Les retombées de ce projet de recherche sont multiples pour les cliniciens, l’étude fournit une meilleure compréhension anatomique tridimensionnelle du triangle fémoral et les techniques proposées dans ce mémoire pourront apporter une amélioration de la pratique chirurgicale et faciliter le travail des médecins. Toutefois, ces propositions devront maintenant être validées en clinique. / In vascular surgery, access to the femoral artery is frequently used either through a surgical incision of the groin or by a percutaneous approach in a wide variety of vascular and endovascular procedures; for multiple bypasses, treatment of arterial occlusions, aneurysms repair and placement of various stents. The general purpose of this study is to facilitate and reduces the risks of both the surgical and the percutaneous approaches of the femoral artery through a better anatomical understanding of the femoral triangle. The methodology was conducted on specifically embalmed cadavers according to the method developed by Walter Thiel. The results presented in this memory allowed us to propose solutions to clinical problems in vascular surgery. First, the study of the cutaneous vascularisation of the femoral triangle led to suggest new surgical approaches in order to reduce lesions of the cutaneous arteries and the potential devascularization of the borders of the wound yielding a better postoperative outcome. Then, we validated the radiographic and ultrasonographic position and identification of the inguinal ligament and the proximal femoral artery to facilitate the identification of a safe arterial puncture site. Moreover, we developed a simple method for ultrasound-guided arterial puncture, suitable for obese patients, to facilitate the percutaneous approach of the femoral artery. The benefits of this research project are multiple for clinicians, the study provides a better tridimensional anatomic understanding of the femoral triangle and the techniques proposed will lead to an improved surgical practice and facilitate the work of doctors. However, our work and propositions still need to be validated clinically.

Aims: The overall aim was to determine how lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO) affect sleep, health related quality of life and disease specific quality of life, and how the men’s urinary symptoms affect their partners. Subjects and methods: In papers I–II, a descriptive design with a pre-test and post-test was used and in papers III-IV the design was descriptive and comparative. The method was self-administered questionnaires. In papers I- II: The questionnaires were translated in the ethnographic mode. In paper I the reliability of the questionnaire was tested in 122 patients with LUTS/ BPO. The disease specific quality of life was studied before and after intervention in 572 consecutive patients with BPO, aged 45-94 yrs. In paper II, the partner specific quality of life was studied in partners to men with BPO before and after TURP. The reliability and the responsiveness of the questionnaire were tested in two groups with 51 partners each. Papers III-IV: A study of 239 men with LUTS, aged 45-80 yrs, and their partners (n=126) who were compared to randomly selected men from the population (n=213) and their partners (n=131). The men had an extra control group, men with inguinal hernia (n=200). Sleep and health related quality of life was studied in both men and their partners. The partners’ specific quality of life was also studied and the men with LUTS answered questions about urinary symptoms and disease specific quality of life. Results: Papers I-II: All the tested questionnaires showed an acceptable reliability and responsiveness. I: Before and after intervention the prevalence of urinary incontinence was 46 % and 16 % respectively. II: Partners were affected by the patients’ BPO symptoms before and improved after the patients TURPs. III: Most sleep variables were significantly impaired in men with LUTS compared to one or both of the control groups. The men with LUTS had a significantly higher prevalence of insomnia (40 %) than both control groups and significantly lower sleep efficiency (49 %) than men with hernia. The men with LUTS were significantly impaired in most domains of the health related quality of life compared to men in the population. IV: There were no significant differences between the two partner groups regarding the quantity and quality of sleep or the health related quality of life. Conclusions: All tested questionnaires showed an acceptable reliability and responsiveness. The prevalence of urinary incontinence before and after intervention was higher than earlier reported. Men with LUTS had significantly poorer sleep quality, reduced sleep efficiency and a higher prevalence of insomnia than men in the population and men with inguinal hernia. The HRQOL is impaired in men with LUTS compared to men in the population and men with inguinal hernia. Partners are affected by the patients’ symptoms, and it is emotional rather than practical aspects that affect them most. Partners of men with LUTS did not differ significantly from partners in the population with regard to sleep and health related quality of life.