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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.




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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, using a chemotherapy regimen based on their stage at relapse as if they are primary patients (i.e. not considering them as relapsed patients), had overall excellent survival [70]. While a small number of patients with recurrence were thus treated with three drug chemotherapy (vincristine, actinomycin-D and doxorubicin), the vast majority required no treatment at all. A recent study from the same CCSS has demonstrated that over the last three to five year intervals of treatment, both the frequency of recurrence of patients treated for all malignancies and that the long term morbidity (not including cancer recurrence deaths) has declined [71]. This is attributed to efforts to decrease the intensity of therapy in generally favorable patients.


Dr. Werner's research is centered on the interaction between ocular tissue and different IOL designs, materials, and surface modifications. These include IOLs implanted after cataract surgery, phakic IOLs for refractive surgery, and ophthalmic implantable devices in general. She has authored more than 300 peer-reviewed publications and book chapters on the subject, coedited 3 books, and received numerous awards at international meetings for scientific presentations, videos, and posters. She has also been a guest speaker at international meetings in at least 20 countries and is a consultant to companies manufacturing IOLs and other ocular biodevices.


Dr. Koch's clinical and research interests are in cataract and refractive surgery, including astigmatism analysis and management, corneal topography, wavefront technology, surgical techniques and prevention of complications, intraocular lens calculations, and surgical instrument design. He has authored more than 200 articles and book chapters on the topics of cataract and refractive surgery.


Dr. Obstbaum has authored or coauthored more than 100 articles, editorials, books and book chapters on lens and glaucoma relationships, ocular inflammation related to cataract surgery, and refractive surgery. He has also served on the editorial boards of the Archives of Ophthalmology; the Asia-Pacific Journal of Ophthalmology, advisory board; and the Hong Kong Journal of Ophthalmology, advisory board.


Dr. Alió has been the author or co-author of more than 497 peer-reviewed papers published in prestigious international scientific journals, 325 book chapters, 87 books (as editor or co-editor), over 354 collaborations in ophthalmic scientific journals, and more than 2,187 presentations and invited lectures in international meetings. The Hirsch factor (h-index) of Dr. Alió is 55 (Scopus). Dr. Alió has been listed with a field rating of 19 among top authors worldwide in ophthalmology during the last 5 years by Microsoft Academic Search. He is author of 36 patents and holds the LXIII chair of the Academia Ophthalmologica Internationalis and XLIX chair of the European Academy of Ophthalmology. He is a member of the International Intra-Ocular Implant Club and has received a total of 94 international and national awards. He is the creator and director of the first online course in refractive surgery from the Miguel Hernandez University, "Scientific Methodology in Refractive, Cataract and Cornea Surgery," which has been offered since 2015.


Dr. Assia has published 140 peer-reviewed papers in leading professional journals and an additional 40 publications and 25 chapters in books. Dr. Assia developed several original patented devices and instruments including the IOPtimate for the CLASS procedure (CO2 laser assisted sclerectomy), the AssiAnchor (Hanita Lenses), APX-200 pupil expander (APX Ophthalmology), and accommodative add-on lens (VisiDome). He is organizer of the Annual Conference of Ocular Microsurgery, the biggest ophthalmology meeting in Israel.


Her main fields of interest are anterior segment, refractive surgery and corneal surgery. In terms of research activities, she is a member of the Medical Imaging Laboratory (Brest Inserm LATim). Dr Cochener is invited to many conferences across the world; she has contributed to more than 150 publications and 8 books on cornea and refractive surgery. She was in charge of the SFO national report dedicated to presbyopia in 2012 and had 2 books on refractive surgery published in 2016.


Dr. Güell's areas of interest are full- and partial-thickness corneal transplantation (deep anterior lamellar keratoplasty and endothelial keratoplasty), complex cataract, and anterior segment reconstructive procedures including permanent keratoprosthesis surgery (artificial cornea). He also specializes in refractive surgery, specifically the excimer and femtoseconf laser, iris claw-style phakic intraocular lens (Artisan, Artiflex), and intracorneal ring segments. He has been awarded 10 honorary medal lectures internationally, including the Ridley Medal lecture at the ESCRS annual congress in Copenhagen in 2016. He has lectured nationally and internationally since 1991. He has given 700 conference talks and has authored 250 articles in peer-reviewed journals as well as several book chapters.


Dr. Hoffman has authored more than 350 publications in numerous ophthalmic journals and textbooks. He has performed live surgery internationally and has made hundreds of presentations at both international and national academic meetings and instructional courses. He has won numerous Best of Session awards for his presentations and Best of Show awards for his teaching video productions. In 2013, he received the AAO Senior Achievement Award for his teaching contributions within that organization.


Dr. Lewis has published more than 90 articles and book chapters focusing on glaucoma, ophthalmic surgery, and ophthalmic pharmacology. He is co-author of the book Curbsides in Glaucoma. He teaches and lectures extensively on glaucoma and cataract surgery. He has received the American Academy of Ophthalmology (AAO) Honor and Senior Honor as well as the Secretariat and Life Achievement Awards for his contributions in teaching and leadership and for initiating the AAO Subspecialty Day meeting.


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