Browsing by Author "Wilhelm, T.J."

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Anaesthesia for Elective Inguinal Hernia Repair in Rural Ghana - Appeal for Local Anaesthesia in Resource-poor Countries
(SAGE PUBLICATIONS INC , 2455 TELLER RD, THOUSAND OAKS, USA, CA, 91320, 2006-07-01) Wilhelm, T.J.; Anemana, S.; Kyamanywa, Patrick; Rennie, J.; Post, S.; Freudenberg, S.
Local anaesthesia has been identified as the most favourable anaesthesia for elective inguinal hernia repair with respect to complication rate, cost-effectiveness, and overall patient satisfaction. Operation theatre notes in all seven hospitals in the Northern Region in Ghana over the period of 1 year were reviewed. Only 22.4% out of 1038 repairs were performed under local anaesthesia while predominantly spinal and general anaesthesia were used (48.0 and 29.6%, respectively). African surgeons chose local anaesthesia far less frequently than visiting overseas surgeons (15.6 versus 27.7%, respectively). All surgeons in resource-poor countries should be encouraged to use local anaesthesia more frequently for elective inguinal hernia repair. Valuable resources in sub-Saharan African hospitals could be saved, especially if used in combination with outpatient surgery. The technique should be taught in teaching institutions. A simple step-by-step technique is described.
Sterilized Mosquito Net Versus Commercial Mesh for Hernia Repair: An Experimental Study in Goats in Mbarara/Uganda
(KARGER , ALLSCHWILERSTRASSE 10, BASEL, SWITZERLAND, CH-4009, 2007-08) Wilhelm, T.J.; Freudenberg, S.; Jonas, E.; Grobholz, R.; Post, S.; Kyamanywa, Patrick
Background: In industrialized countries alloplastic meshes are routinely used for hernia repair. However, in developing countries they are rarely available or affordable. This study compares textile properties and tissue response of commercial polypropylene mesh (PM) vs. sterilized nylon mosquito net (MN). Methods: Textile properties were examined in vitro. In 12 goats one MN and one PM (5.5 ! 8 cm) were implanted onto the posterior layer of the rectus sheath. Wound healing was clinically assessed. Histology was assessed after 4 or 16 weeks. Results: MN was thinner and lighter, but weaker than PM. All wounds healed without complications. After 16 weeks foreign body granulomas in the MN group contained a higher proportion of inflammatory tissue (32.7 vs. 22.1%) and more giant cells (3.1 vs. 1.7/10 granulomas) with a significantly lower partial volume of foreign body (23.2 vs. 36.9%). Partial volume of fibrotic tissue was similar. MN was 1,000-fold cheaper than PM. Conclusions: PM was superior concerning strength and extent of inflammatory response. However, the findings indicate that MN might serve as a cheap substitute if an alloplastic mesh is needed but no commercial one is available or affordable. Further studies are justified which should include mosquito nets of different materials and long-term outcome.