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stephen munyao
stephen munyao

Norman Browse Surgery Book Free 22


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Norman Browse Surgery Book Free 22


processing.... Drugs & Diseases > Clinical Procedures Open Inguinal Hernia Repair Updated: May 21, 2021 Author: Vinay K Kapoor, MBBS, MS, FRCSEd, FICS, FAMS; Chief Editor: Kurt E Roberts, MD more... Share Email Print Feedback Close Facebook Twitter LinkedIn WhatsApp webmd.ads2.defineAd(id: 'ads-pos-421-sfp',pos: 421); Sections Open Inguinal Hernia Repair Sections Open Inguinal Hernia Repair Overview Practice Essentials Background Indications Contraindications Technical Considerations Outcomes Show All Periprocedural Care Preprocedural Planning Equipment Patient Preparation Monitoring & Follow-up Show All Technique Approach Considerations Lichtenstein Tension-Free Mesh Repair Other Approaches Postoperative Care Complications Show All Medication Medication Summary Local Anesthetics Local Anesthetic/NSAID Combination Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Analgesics Show All Questions & Answers Media Gallery References Overview Practice Essentials Inguinal hernia repair is one of the most commonly performed surgical procedures in the world. Most surgeons now prefer to perform a tension-free mesh repair. The Lichtenstein tension-free hernioplasty is currently one of the most popular techniques for repair of inguinal hernias.


Lichtenstein open tension-free mesh hernioplasty is suitable for all adult patients, irrespective of age, weight, general health, and the presence of concomitant medical problems. For patients with large scrotal (irreducible) inguinal hernias, those who have undergone major lower abdominal surgery, and those in whom no general anesthesia is possible, the Lichtenstein repair is the preferred surgical technique.


As the number of patients surviving from Wilms tumor has grown, evidence of the long term morbidity of these patients has become evident as discussed in this chapter. The Childhood Cancer Survivor Study (CCSS) has performed a series of excellent evaluations of these patients and the long term morbidity of therapy has been well documented. In fact, significant morbidity has been demonstrated in 65.4% of patients who have survived over 25 years following treatment for Wilms tumor and 24% have severe morbidity [62]. The cumulative incidence of mortality for the Wilms tumor survivors is 6.1% which is almost five times that of their siblings. These long term results have resulted in attempts to decrease or, in fact, avoid all use of adjuvant chemotherapy. Dan Green and the investigators performing the NWTS-5 study identified a cohort of children who were deemed as having "very low risk Wilms tumors": patients under a year of age with favorable histology tumors which were stage 1 and in which the weight of the tumor and kidney were under 550 grams. Dr. Green had the temerity to question if all patients with Wilms tumor should be treated with adjuvant chemotherapy as had been espoused by Sidney Farber. This cohort of patients had an overall survival rate of 95% regardless of the type of chemotherapy they received on past protocols. Dr. Green postulated that a high percentage of these patients might do quite well without receiving any adjuvant chemotherapy. In NWTS-5 a single arm study of patients who met these criteria were treated with surgery alone and received no adjuvant chemotherapy. In 1998, this study was closed as the frequency of recurrence exceeded the limits set by the protocol [50]. It had been presumed that fifty percent of the patients who relapsed could be salvaged based on experience from prior NWTSG studies. What was found in the long term follow-up of these patients, however, was a very high rate of salvage unpredicted by the results of prior studies [51]. A subsequent follow-up study performed by COG lowered the event free survival allowed based on the very high salvage rate seen in the prior study. That study demonstrated that these patients continue to do quite well without use of adjuvant chemotherapy. If they do relapse,




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