A Randomized Trial Comparing Lichtenstein Repair and No Mesh Desarda Repair for Inguinal Hernia: A Study of 1382 Patients

Background: The objective of this study is to compare the outcomes of Lichtenstein repair and no mesh Desarda repair for inguinal hernia.Methods: This is a prospective randomized trial of 1382 patients having 1461 hernias operated from January 2002 to December 2011.704 patients were operated using Lichtensteinrepairand 678 using Desardarepair. The variables like age, sex, type of hernia, duration of surgery, pain on thefirst, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years).Results: There were no significant differences regarding age, sex, type of hernia, and pain in both the groups. The operation time was 48 minutes in Desarda group and 39 minutes in the Lichtenstein group that is significant (p<0.05).The recurrence was 0.5 % in Desarda group and 0.4% in Lichtenstein group. There were 8 cases of infection to the polypropylene mesh in the Lichtenstein group, 3 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (7.5%) as compared to Desarda group (3.4%). The mean time to return to normal routine non-strenuous work in the Desarda group was 8.26 days v 12.58 days in the Lichtenstein group. The mean hospital stay was 29 hrs. in Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized.Conclusions: Desarda repair scores significantly over the Lichtenstein repair. Morbidity due to complications and re-explorations for sepsis were significantly higher in mesh group. Period of return to normal work was also less in the Desarda group. No mesh Desarda repair is a better choice as compared with the Lichtenstein mesh repair.Key words: Lichtenstein, Desarda, Inguinal, Hernia, Repair, Randomized, Trial

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p