Shouldice Versus Lichtenstein Hernia Repair Techniques: A Prospective Randomized Study

Background: The objectives of this study was to compare the tension-free mesh (Lichtenstein), and the 4-layer tissue repair (Shouldice) techniques of inguinal hernia surgery and to determine to what extent doctors in a general surgical unit were able to reproduce the excellent results reported from specialist hernia centres.Methods: Patients with primary unilateral inguinal hernia were over an 18month period randomized to either the Shouldice group (experiment) or to the Lichtenstein group (control). The operating time, convalescence, hospital stay, postoperative analgesic consumption and complications, were assessed and compared.Results: There Lichtenstein group had a shorter operating time but had a higher occurrence of persistent postoperative pain compared to the Shouldice group. There was no significant difference in convalescence  between the two groups and no recurrences have been recorded in eithergroup. Conclusion: Despite Shouldice being more challenging to perform  compared to Lichtenstein, the postoperative results are comparable. Ourexperience shows that both procedures can be taught to medical officers who can perform them with relative safety, efficacy and reproducibility tosurgeons. Shouldice method being the more cost effective procedure should be encouraged in men with primary unilateral inguinal hernias.Key Words: Hernia, Lichtenstein, Shouldice, Clinical Tria

Chronic Ileocecal Intussusception Secondary to Non-Hodgkins Lymphoma

Chronic intussusception is a distinct clinical entity which is unfortunately poorly recognized due to its atypical presentation. A 5½ year old female  patient presented with a 5 month history of abdominal pain associated with occasional vomiting, anorexia and progressive weight loss. 5 days prior to admission she developed loose, non-mucoid, non-blood stained stool associated with refusal to feed and irritability. Systemic examination, an abdominal ultrasound and abdominal radiograph were non-contributory.During treatment for malnutrition and dehydration she was noted to clinically improve, however, 6 days post-admission she developed  abdominal pain, a palpable sausage-shaped abdominal mass, and currant-jelly stool. Emergency laparotomy revealed an ileocecal  intussusception with oedematous nonviable, aperistaltic terminal ileum and mobile cecum, a cecal mass and mesenteric lymphadenopathy was found. We performed a right hemicolectomy with an ileocolic anastomosis and mesenteric lymph node sampling. Histology results revealed the cecal  mass as a lymphoproliferative neoplasm with a diagnostic consideration of intermediate to large cell Non-Hodgkins Lymphoma; and reactive  hyperplasia of mesenteric lymph nodes. There is need for a highindex of suspicion in children with non-specific abdominal symptoms for which no cause can be found. Further, all suspicious masses should haveimmunohistological histological evaluation.Key Words: Chronic Ileocecal Intussusception, Non Hodgkins Lymphom