Fistulotomy with or without marsupialisation of wound edges in treatment of simple anal fistula: a randomised controlled trial

Background Promotion of healing of the anal wound after fistulotomy may help accelerate recovery and return to work. The present study aimed to assess the effect of marsupialisation of the edges of the laid open fistula track on wound healing after anal fistulotomy for simple anal fistula. Methods This was a prospective randomised trial on patients with simple anal fistula. Patients were randomly assigned to one of two groups; group I underwent anal fistulotomy and group II underwent anal fistulotomy and marsupialisation of the edges of the laid open track. Outcomes of the study were time to achieve complete wound healing, operation time, postoperative pain and complications. Results Sixty patients of mean age of 40.8 years with simple anal fistula were randomly divided into two equal groups. No significant differences between the two groups regarding operation time (16.8 vs 18.4 minutes; P = 0.054), postoperative pain score (1.6 vs 1.2; P = 0.22), and complication rates were recorded. Group II achieved complete healing in a significantly shorter duration than group I (5.1 vs 6.7 weeks; P < 0.0001). Conclusion Marsupialisation of the edges of the laid open fistula track after fistulotomy resulted in quicker wound healing with similar complication and recurrence rates to lay open fistulotomy alone.

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Feasibility of Endoscopic Thyroidectomy via Axilla and Breast Approaches for Larger Goiters: Widening the Horizons

Journal of Thyroid Research ◽

10.1155/2018/4057542 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 7

Author(s):

Goonj Johri ◽

Gyan Chand ◽

Nitish Gupta ◽

Chaitra Sonthineni ◽

Anjali Mishra ◽

...

Keyword(s):

Endoscopic Thyroidectomy ◽

Operation Time ◽

Vocal Cord Palsy ◽

Perioperative Outcomes ◽

Complication Rates ◽

Group I ◽

Conversion Rates ◽

Significant Difference ◽

Group Ii

Scarless (in the neck) endoscopic thyroidectomy (SET) has evolved into a cosmetically preferred alternative to conventional thyroidectomy (ConT). Recently many of our patients are demanding SET; however their goitres are larger than the recommended size of 4–6 cm. Our aim was to compare the outcomes of ET for small (<6 cm) vs large (≥6 cm) goitres and determine its feasibility in such cases. This is a retrospective analysis of prospectively maintained database of patients undergoing ET. Patients were divided into 2 groups: I, small (<6 cm) and II, large goitres (≥6 cm). Their demographic and clinicopathological profiles, operation time, conversion and complication rates, and hospital stay were compared. 99 patients (101 procedures) were included: group I, 60 patients (61 procedures), and group II, 39 patients (40 procedures). Mean tumor size (± SD) was 4.4 ± 0.9 cm and 6.7 ± 1.1 cm in groups I and II, respectively. The groups were comparable with respect to demographic and clinical profile except for mean duration of goiter [30.1 ± 32.6 months (group I) vs 60.5 ± 102.4 months (group I), p = 0.03] and gland weight [21.5 ± 15.3 grams (group I) vs 62.3 ± 51.3 grams (group II), p = 0.001]. Although there was no significant difference between mean operating times, long term perioperative outcomes, and conversion rates, temporary hypocalcaemia and length of stay were longer in group II. One patient had permanent vocal cord palsy (~1%, 1/101); none had permanent hypoparathyroidism. Our results indicate that ET can be offered to a subset of patients with larger goitres desirous of SET with no significant difference in mean operation time, conversions, and long term postoperative complications in experienced hands.

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RECURRENCE RATE AFTER REPEAT TRANSURETHRAL RESECTION AMONG PATIENTS WITH NEWLY DIAGNOSED T1 BLADDER CANCER

10.36106/ijar/7213765 ◽

2021 ◽

pp. 51-54

Author(s):

Md. Shafiqur Rahman ◽

Sanjeeb Bhakta Bista ◽

Md. Sayedul Islam ◽

A. S. M. Shafiul Azam ◽

Md. Shamim Hossain ◽

...

Keyword(s):

Bladder Cancer ◽

Recurrence Rate ◽

Transurethral Resection ◽

Tumor Recurrence ◽

Controlled Trial ◽

Intravesical Therapy ◽

Newly Diagnosed ◽

Group I ◽

Group Ii

Background: Transurethral resection of the bladder tumor (TURBT) is the cornerstone of diagnosis and TURBT followed by selective adjuvant intravesical chemotherapy or immunotherapy is the gold standard of treatment for the patients with non-muscle invasive bladder cancer (NMIBC). Even after complete resection of the tumor there is high risk of residual tumor and subsequent recurrence and progression of the disease. The recurrence of T1 tumor is found to be around 71 % within 5 years and High grade T1 lesions recur in more than 80% of the cases and progress in 50% of the patients within 3 years. Disease status at 3 months after initial resection is an important predictor of subsequent recurrence and progression. To assess the tumor recurrence rat Objective: e among patients with newly diagnosed T1 bladder cancer between repeat transurethral resection group and single TURBT group. Ra Type of study: ndomized controlled trial. Place of study: Department of urology, BSMMU, Dhaka, Bangladesh. This Randomi Materials And Methods: zed Controlled Trial was conducted in urology department of BSMMU, Dhaka, Bangladesh from February 2017 till September 2018. A total of 50 patients, diagnosed as a case of T1 bladder cancer and who fulll the selection criteria were randomly divided in two groups consisting of 25 patients in each group. After informed consent, repeat TUR was done after 4 weeks of the initial TURBT for only 22 patients in group I since 3 of the patients did not show up on the scheduled date of surgery. Whereas, repeat TUR was not done for other 25 patients in group II. All the patients in both the groups were further treated with intravesical therapy according to the histopathological report. The patients in both the groups were followed up at 3 months and 6 months of the initial intervention where detailed history was taken, relevant investigations were done and check cystoscopy was done. TURBT was done for recurrent tumors. Out of 22 patients in group I, 2 patients were excluded for follow up on the basis of repeat TUR ndings. Whereas in group II, 2 patients missed the follow up and one of them missed the normal scheduled dose of intravesical therapy. Hence, 22 patients completed the study in group II. The baseline variables like age and Results: sex were similar in both the groups with higher male predominance. There was no statistical signicant difference in tumor characteristics such as size, number and grade of the tumor between the two groups. Out of 22 patients in group I who underwent repeat TUR at 4 weeks of initial TUR, residual disease was found in 8 (36.36%) patients. One of the patient was found to have T2 disease and 1 patient had CIS during repeat TUR. These 2 patients were not followed up since the treatment strategy changed after the results of repeat TUR. After 6 months of follow up of all the patients, 2 (10%) out of 20 patients in group I were found to have tumor recurrence however, in group II, 9 (40.9%) patients had tumor recurrence. The tumor recurrence rate between the two groups was found to be statistically signicant (p=0.023). In the light of ndings of this Conclusion: study, it can be concluded that performing repeat transurethral resection in patients with newly diagnosed T1 bladder cancer at 4 weeks of initial TURBT, helps to detect signicant number of residual tumor and reduce early recurrence rate of the tumor.

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Excision with primary midline closure compared with Limberg flap in the treatment of sacrococcygeal pilonidal disease: a randomised clinical trial

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0144 ◽

2019 ◽

Vol 101 (1) ◽

pp. 21-29 ◽

Cited By ~ 4

Author(s):

M Arnous ◽

H Elgendy ◽

W Thabet ◽

SH Emile ◽

SA Elbaz ◽

...

Keyword(s):

Clinical Trial ◽

Hospital Stay ◽

Recurrence Rate ◽

Primary Closure ◽

Randomised Clinical Trial ◽

Limberg Flap ◽

Complication Rates ◽

Cosmetic Results ◽

Group I ◽

Group Ii

BackgroundAlthough several surgical techniques for treatment of sacrococcygeal pilonidal sinus (SPND) have been described, there is no consensus on the optimal surgical procedure. In this study we compared excision with primary closure and Limberg flap in the treatment of SPND.MethodsThis was a prospective randomised clinical trial in patients with SPND who were randomly allocated to one of two groups: group I (excision and primary closure) and group II (Limberg flap technique). The primary outcome of the trial was recurrence of SPND whereas postoperative complications, return to work and cosmetic results were the secondary outcomes.ResultsSixty patients were included, with a mean age of 24.1 years and mean body mass index (BMI) of 26.8 kg/m2. Group 1 had significantly shorter operation time than group II. Both groups had similar hospital stay and comparable complication rates (43.3% vs 30%; P = 0.4). Group I had significantly higher recurrence rate (20% vs 0; P < 0.02) and significantly better cosmetic satisfaction score than group II. Being hairy (P = 0.04), positive family history (P = 0.03), diabetes mellitus (P = 0.005) and history of previous surgery for SPND (P = 0.01) were the significant predictors for recurrence.ConclusionsThe Limberg flap is an effective technique for the treatment of SPND with very low recurrence rate and comparable complication rate and hospital stay to excision and primary closure. Excision and primary closure offered the advantages of quicker healing time, earlier resumption of daily activities, better cosmetic results, which may render it more suitable for patients with low risk for recurrence.

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A comparative study between fistulotomy and fistulectomy in management of low anal fistulae

International Surgery Journal ◽

10.18203/2349-2902.isj20174882 ◽

2017 ◽

Vol 4 (11) ◽

pp. 3665 ◽

Cited By ~ 2

Author(s):

Ganesan R. ◽

Karunakaran K. ◽

Heber Anandan

Keyword(s):

Wound Healing ◽

Operating Time ◽

Healing Time ◽

Human Beings ◽

Fistula In Ano ◽

Post Surgery ◽

Group I ◽

Hospital Stays ◽

Group Ii ◽

Wound Healing Time

Background: Fistula in ano is a silent menace in human beings, the treatment is a challenging one even for experienced surgeons, fistula in ano forms a good majority of treatable benign lesions of rectum and anal canal. Aim was to study the efficacy of fistulotomy and fistulectomy in the treatment of low anal fistulae.Methods: A randomized control study was conducted to compare fistulotomy with fistulectomy in patients with low anal fistulae.Results: The operating time in fistulotomy group was 12.13minutes±2.11minutes and in fistulectomy group was 22.23±3.36minutes. The post-surgery hospital stays in Group I was 1.80±0.66days and in Group II was 2.60±0.563 days. The wound healing time in Group I was 24.20±2.95 days which was considerably less when compared to patients in Group II where it was 31.50±4.34 days.Conclusions: Fistulotomy has a slight edge over fistulectomy in the treatment of low anal fistulas since it has shorter operating time, less post-operative pain, less complications, quicker wound healing time, less incontinence and a comparable recurrence rate.

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A randomised trial of 5% minoxidil versus combination of 5% minoxidil and oral spironolactone in treatment of female pattern hair loss

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20194565 ◽

2019 ◽

Vol 5 (4) ◽

pp. 668

Author(s):

Nachiket Madhukarrao Palaskar ◽

Nitin Dinkar Chaudhari ◽

Garima Laxminarayan Balpande ◽

Swapna Subhash Khatu

Keyword(s):

Combination Therapy ◽

Hair Loss ◽

Tertiary Care ◽

Randomised Trial ◽

Life Questionnaire ◽

Care Hospital ◽

Female Pattern Hair Loss ◽

Group I ◽

Topical Minoxidil ◽

Group Ii

Background: Female pattern hair loss (FPHL) is a common form of nonscarring hair loss. We compared the usefulness and safety of topical minoxidil alone with combination of oral spironolactone and topical minoxidil in the treatment of FPHL.Methods: This prospective, single-centre, randomised open label study over 100 patients attending tertiary care hospital in Mumbai during period December 2011 to June 2012. The data were entered into SPSS version 21 for analysis. Data collected were coded and described as frequency and percentage for qualitative data and means and standard deviation for quantitative data. Statistical analysis was done using chi-square and student t test. Statistical significance was considered if p value was less than 0.05.Results: There were 48 patients in Group I and 46 patients in Group II. At 6 months, significantly higher mean Sinclair grade was observed among Group I patients as compared to Group II patients (2.85±0.68 vs 2.56±0.50, p=0.02). We observed a significant improvement in women’s androgenetic alopecia quality of life questionnaire in Group I patients at 12 months after treatment (26.93±2.25 vs 23.47±2.95, p<0.001). Minoxidil and spironolactone were tolerated well by the patients.Conclusions: Combination therapy of topical minoxidil and oral spironolactone has an additive effect. However, plateau of effectiveness of the combination therapy in normoandrogenic patients at 6 months of therapy was observed. We recommend the combination for 6 months and continuation of therapy with minoxidil only.

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Clinic Results of Intraductal Meibomian Gland Probing Combined Intense Pulsed Light in Treating Patients With Refractory Obstructive Meibomian Gland Dysfunction: A Randomized Controlled Trial

10.21203/rs.2.4294/v1 ◽

2019 ◽

Author(s):

Xiaodan Huang ◽

Qiyu Qin ◽

Linping Wang ◽

Jiao Zheng ◽

Lin Lin ◽

...

Keyword(s):

Controlled Trial ◽

Symptom Relief ◽

Meibomian Gland ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

Pulsed Light ◽

Group I ◽

Final Treatment ◽

Group Ii ◽

Better Than

Abstract Background: To optimize therapeutic regimen for refractory obstructive meibomian gland dysfunction (o-MGD) patients by combining intraductal meibomian gland probing (MGP) and intense pulsed light (IPL) to enhance their effect and reduce their limitations. Methods: This randomized, assessor blind study include 45 patients (90 eyes) with refractory o-MGD. They were divided into 3 groups by allocation concealment: IPL (group I, received an IPL treatment course: 3 times at 3-week intervals), MGP (group II, received MGP one time) and MGP combined IPL (group III, MGP at first then an IPL treatment course). Standard Patient Evaluation of Eye Dryness score (SPEED), tear break-up time (TBUT), corneal fluorescein staining (CFS), meibum grade and lid margin finding results were assessed at baseline, 3 weeks after final treatment in group I and III, 3 and 12 weeks after MGP in group II. Six months after final treatment, the SPEED and willingness to receive any treatment again were also collected in all groups. Paired Wilcoxon, Mann-Whitney U with Bonferroni correction and Kruskal-Wallis tests were used for data analysis. Results: In 3 groups, all above indexes improved significantly after treatment (all P＜0.01). MGP-IPL was better than IPL and MPG in posttreatment SPEED, TBUT, meibum grade, lid telangiectasia (all P＜0.05/3). Besides, the MGP-IPL was better than IPL in lid tenderness and better than MGP in orifices abnormality (all P＜0.05/3 ). Six months later, the SPEED in MGP-IPL was also significantly lower than other groups (all P＜0.05/3). And no patients in MGP-IPL group revealed the need to be treated again, while 35.7% or 20% of patients with IPL or MGP need retreatment. Conclusions: Compared with single IPL or MGP, the combination of MGP and IPL demonstrated the most efficient results in relieving all signs and symptoms and can help patients attain the most lasting symptom relief. Trial registration: http://clinicaltrials.gov, ChiCTR1900021273 (retrospectively registered 09 February 2019). Funding: This work was supported by the National Natural Science Foundation of China: [grant numbers: 81870624; 81700802]; Major Science and Technology Projects of Zhejiang Province [grant numbers: 2017C03046].

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On-shelf Streptokinse EnsuRes More Favorable In-hospital Outcome after Acute STEMI (OSTRIC trial) - A Single Centre Randomized Controlled Trial

Bangladesh Heart Journal ◽

10.3329/bhj.v33i2.39309 ◽

2018 ◽

Vol 33 (2) ◽

pp. 126-133

Author(s):

Afzalur Rahman ◽

Mohammad Arifur Rahman ◽

Farhana Ahmed ◽

Rezvey Sultana ◽

Nabil Amin Khan

Keyword(s):

Cardiogenic Shock ◽

Hospital Stay ◽

Controlled Trial ◽

Primary Pci ◽

Injection Time ◽

Cardiac Events ◽

Mortality And Morbidity ◽

Acute Stemi ◽

Group I ◽

Group Ii

Introduction: The burden of CAD is increasing at a greater rate in South Asia than in any other region globally. Among them acute ST elevation myocardial infarction (STEMI) is one of the leading causes of death and disability. Major aspect of treatment of acute STEMI is reperfusion of the infarct related artery. Delay in reperfusion is associated with higher mortality and morbidity rates. While primary percutaneous coronary intervention (PCI) is the preferred mode of reperfusion, only few patients can get this form of reperfusion within recommended timelines. On the other hand, thrombolysis is easily available, economical and evaluated in several clinical studies. Thrombolysis is an important reperfusion strategy, especially when primary PCI cannot be offered to STEMI patients, with a time dependent fashion. Methods: This randomized controlled trial was conducted in the department of Cardiology of National Institute of Cardiovascular Diseases since January 2016 to June 2018. Objective of the study was to find out the outcomes of acute STEMI patients after getting on-shelve or purchased Streptokinase (STK). Initially there was no free supply of STK in our hospital as it is an expensive drug, later on fund was arranged and STK was made available at free of cost by the hospital authority. Total 300 patients fulfilling inclusion and exclusion criteria were included in the study. Group I: 150 patients received on-shelf STK when it was made free by the authority and Group II: 150 patients received purchased STK when it was not available at free of cost. Study populations were analyzed for LVF, Cardiogenic shock, MACE (re-infarction, stroke and death) and duration of hospital stay. Results: The mean age of the study population in group I and II were 53.88 ± 14.51 vs. 57.18 ± 15.28 years (p= 0.46). Mean door to injection time in group I and II were 25.51 ± 7.9 vs. 70.36 ± 16.6 minutes (p=<0.001). ST segment resolution was significantly higher in on-shelf STK group then purchased group which were 109 (72.7%) vs. 92 (61.3%), p=0.03. Considering the in-hospital outcome we found that in group I and group II LVF (killip III/IV) was 10 (6.7%) vs. 23 (15.3%) , Cardiogenic shock was 11 (7.3%) vs. 24(16%) , re-infarction was 9(6%) vs. 13 (8.7%) , Stroke was 6 (4%) vs. 8 (5.3%) and death was 12 (8%) vs. 23(15.3%). Among them LVF (killip III/IV), Cardiogenic shock and Death were significantly higher in group II (p=0.02, 0.01 and 0.04 respectively). Major adverse cardiac events (MACE) included re-infarction, Stroke and death, were significantly higher in group II [27 (18%) vs. 44(29.3), p= 0.02]. Mean hospital stay was significantly higher in group II (6.05 ± 1.81) then group I (5.33±1.26), (p=<0.001). Multivariate logistic regression analysis showed hypertension (p=.025) and door to injection time (p=.002) were statistically significant predictors for in-hospital major advance cardiac events (re-infarction, stroke and death) after streptokinase therapy. Conclusion: Despite the strength of evidence based medicine pertaining to the benefits of primary PCI in STEMI, treatment options in Bangladesh are often dictated by resources, logistics, availability and affordability. In our country, not many hospitals offer primary PCI services round the clock. So thrombolysis by streptokinase it the potential reperfusion strategy in our context. In our study it has been found that onshelf Streptokinase significantly reduce door to injection time which ultimately reduce cardiovascular mortality and mortality and also significantly reduce hospital stay. Hospitals intended to treat acute STEMI patients should have on-shelve Streptokinase to reduce door to injection time which affect the inhospital outcome by reducing significant cardiovascular mortality and morbidity. Bangladesh Heart Journal 2018; 33(2) : 126-133

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Wound Healing: An Endpoint for Complex Peripheral Angioplasty

Journal of Endovascular Therapy ◽

10.1177/152660289500100112 ◽

1994 ◽

Vol 1 (1) ◽

pp. 88-91 ◽

Cited By ~ 1

Author(s):

John R. Crew ◽

Marilyn Thuener

Keyword(s):

Wound Healing ◽

High Risk ◽

San Francisco ◽

Wound Management ◽

Group Iii ◽

High Risk Patients ◽

Group I ◽

Risk Patients ◽

Group Ii ◽

End Stage

Purpose: The standard endpoint for lower limb revascularization is long-term patency; however, in high-risk patients with end-stage ischemia, healing of chronic ulcerations has been proposed as an acceptable endpoint. To evaluate if today's minimally invasive interventions, in combination with comprehensive wound healing procedures, can resolve nonhealing wounds, we performed a retrospective review of chronic ulceration patients treated at the San Francisco Wound Care Center. Methods: Eight-five patients with 96 limbs at risk due to nonhealing ulcers were treated with a variety of endovacular procedures: 7 patients (group 1) received PalmazR stents for unilateral iliac occlusions; 42 limbs (group II) in 39 patients were treated with balloon angioplasty for superficial femoral and popliteal lesions; and 47 extremities in 39 patients (group III) underwent rotational atherectomy for tibioperoneal lesions. Comprehensive wound management techniques, including the application of growth factors, were used. Results: All group I wounds healed, although 6 of 7 patients required additional procedures to address outflow lesions. In groups II and III, primary patencies were similar (64% and 70%, respectively), and nine treated sites reoccluded in each group. Restenotic lesions were retreated in both groups (three in group II and four in group III); secondary patencies were 71% and 78%, respectively. There were more amputations in group III patients (five) compared to group II (one). In both groups after 5 months, 90% of wounds had healed in group II and 72% in group III. Conclusion: The use of endovascular procedures appears to play an important role in the healing of chronic lower extremity ulcerations in high-risk patients with end-stage ischemia.

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Effect of anticoagulant and antiplatelet agents on outcome of AV Fistula made for hemodialysis access

Nepal Journal of Medical Sciences ◽

10.3126/njms.v1i2.6607 ◽

2012 ◽

Vol 1 (2) ◽

pp. 93-96

Author(s):

N Yogi ◽

M Baxi ◽

J Baxi ◽

GB Acharya ◽

NK Hazra

Keyword(s):

Antiplatelet Agents ◽

Complication Rates ◽

Hemodialysis Access ◽

Medical Sciences ◽

Av Fistula ◽

Group I ◽

Analysis Of Results ◽

Group Ii ◽

Age And Sex

Background: Arteriovenous fistula (AVF) is the primary mode of achieving vascular access for hemodialysis in chronic renal failure (CRF). Because of high complication rates like thrombosis, maintenance of the fistula is a major challenge. Although antiplatelets and anticoagulants are emerging rapidly for improving the outcome of AVF but fear of bleeding, hematoma, subsequent compression of AV fistula and blockade restrict their use in many dialysis centers. Methods: Seventy five patients for whom AVF was created for hemodialysis access from Feb 2005-April 2009 in Manipal Teaching Hospital, Pokhara, Nepal were included in a retrospective study. Analysis of results was done in two different age and sex matched groups; Group I had patients where no anticoagulants or antiplatelets were used and Group II had patients in which antiplatelets/anticoagulants were used. Results: There were 27 patients in group I and 48 patients in group II. Both the groups were followed up till 2 years post operatively to check for the patency of the fistula. AV fistula was repeated in 16 cases altogether. In group II there were 5 (10%) cases of repeat fistula while in group I it was repeated in 11 (40%) cases. Conclusion: Judicious use of antiplatelet/anticoagulant agents in cases of AVF for hemodialysis access can be beneficial in preventing the chances of occlusion of AVF and thus helps in its long term patency. DOI: http://dx.doi.org/10.3126/njms.v1i2.6607 Nepal Journal of Medical Sciences. 2012;1(2): 93-6

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Skin Staples: A Safe Technique for Securing Mesh in Lichtensteins Hernioplasty as Compared to Suture

Surgery Research and Practice ◽

10.1155/2014/958634 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5

Author(s):

Anand Munghate ◽

Sushil Mittal ◽

Harnam Singh ◽

Gurpreet Singh ◽

Manish Yadav

Keyword(s):

Mesh Fixation ◽

Operating Time ◽

Operation Time ◽

Skin Closure ◽

Skin Staples ◽

Group I ◽

Lichtenstein Hernia Repair ◽

Duration Of Surgery ◽

Group Ii ◽

Polypropylene Sutures

Background.Lichtenstein tension free repair is the most commonly used technique due to cost effectiveness, low recurrence rate, and better patient satisfaction. This study was done to compare the duration of surgery and postoperative outcome of securing mesh with skin staples versus polypropylene sutures in Lichtenstein hernia repair.Materials and Methods.A total of 96 patients with inguinal hernia undergoing Lichtenstein mesh repair were randomly assigned into two groups. The mesh was secured either by using skin staples (group I) or polypropylene sutures (group II).Results.The operation time was significantly reduced from mesh insertion to completion of skin closure in group I (mean 20.7 min) as compared to group II (mean 32.7 min) with significantPvalue(P<0.0001)and less complication rate in group I as compared to group II.Conclusion.Mesh fixation with skin staples is as effective as conventional sutures with added advantage of significant reduction in the operating time and complications or recurrence. The staples can be applied much more quickly than sutures for fixing the mesh, thus saving the operating time. Infection rate is significantly decreased with staples.

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