scholarly journals Clinical Analysis of 123 Cases of Acute Colonic Diverticulitis

2020 ◽  
Author(s):  
Zhi Chen ◽  
Bing Zhang ◽  
dan wu ◽  
Ye Jin
Keyword(s):  
Surgical Treatment ◽  
Hospital Stay ◽  
Recurrence Rate ◽  
Sigmoid Diverticulitis ◽  
Colonic Diverticulitis ◽  
Abdominal Drainage ◽  
Significant Difference ◽  
Operation Group ◽  
Length Of Hospitalization ◽  
Acute Colonic Diverticulitis

Abstract Objective: To study the characteristics of acute colonic diverticulitis and the differences between different treatment options.Methods: A retrospective analysis of 123 patients with acute colonic diverticulitis treated in our hospital from April 2013 to April 2020, including operation group (n = 30) and non-operation group (n = 93). The characteristics of acute colonic diverticulitis were analyzed, and the therapeutic effects of acute colonic diverticulitis were compared between the operation group and the non-operation group.Results:111 cases of Caecal and ascending colonic diverticulitis (proportion 90.2%, male to female ratio 2.26: 1, average age 39.6 ± 14.4 years, surgery ratio 24.3%, mean hospital stay 7.4 ± 4.3 days, recurrence rate 3.6%); 3 cases of transverse colonic diverticulitis; 3 cases of descending colonic diverticulitis; 6 cases of Sigmoid diverticulitis (proportion 4.9%, male: female 1: 1, average age 67.7 ± 4.5 years, surgery ratio 33.3%, mean hospital stay 11.7 ± 5.5 Days, recurrence rate 0%).30 patients received surgical treatment, including 15 cases of abdominal drainage, 14 cases of colonic diverticulectomy and repair, and 1 case of sigmoidectomy. There was a statistically significant difference in the length of hospitalization between the operative group and the non- operative group (P = 0.018), and the length of hospitalization was longer in the operative group. There was no significant difference in the recurrence rate between the operative group and the non-operative group of colonic diverticulitis (P = 0.595). Colonic diverticulitis usually relapsed within 1 year. The total recurrence rate was 4.1%.Conclusions: The right-sided colonic diverticulitis is more common in young and middle-aged. There is a higher incidence in males. The effect of non-operative treatment of acute diverticulitis is better than that of surgical treatment. Resection and repair of the diverticulum or abdominal drainage can be used in patients with acute uncomplicated diverticulitis.

scholarly journals Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy

2020 ◽  
Author(s):  
Zhi Chen ◽  
Bing Zhang ◽  
Dan Wu ◽  
Ye Jin
Keyword(s):  
Hospital Stay ◽  
Recurrence Rate ◽  
Sigmoid Diverticulitis ◽  
Colonic Diverticulitis ◽  
Abdominal Drainage ◽  
Female Ratio ◽  
Uncomplicated Diverticulitis ◽  
Significant Difference ◽  
Male To Female ◽  
Acute Colonic Diverticulitis

Abstract Background: In China, diverticulitis is more often located in the right colon, mainly in the cecum and ascending colon. Here we study the characteristics of acute colonic diverticulitis and compare various treatments for acute right-sided colonic diverticulitis.Methods: A retrospective analysis of 123 patients with acute colonic diverticulitis treated in our hospital from April 2013 to April 2020, including 114 cases of right-sided colonic diverticulitis, was performed. The characteristics of acute colonic diverticulitis were analyzed, and the therapeutic effects of different treatments for acute right-sided colonic diverticulitis were compared.Results: 111 cases of caecal and ascending colonic diverticulitis were identified (90.2% of cases, male to female ratio 2.26:1, average age 39.6 ± 14.4 years, surgery ratio 24.3%, mean hospital stay 7.4 ± 4.3 days, recurrence rate 3.6%). Three cases of transverse colonic diverticulitis and three cases of descending colonic diverticulitis were found. Six cases of Sigmoid diverticulitis (4.9% of cases, male to female ratio 1:1, average age 67.7 ± 4.5 years, surgery ratio 33.3%, mean hospital stay 11.7 ± 5.5 days, recurrence rate 0%) were found. 13 patients underwent right-sided colonic diverticulitis resection and repair, while zero patients underwent colectomy. Abdominal drainage was performed in 15 patients with right-sided colonic diverticulitis. There was no significant difference in the length of hospital stay among the three treatments for right-sided colonic diverticulitis (P = 0.05). There was no significant difference in the recurrence rate among the three treatments of right-sided colonic diverticulitis ( P = 0.358). While the recurrence rate of right-sided colonic diverticulitis was only 3.5%, relapse usually occurred within the first year following treatment.Conclusions: In our patients, right-sided colonic diverticulitis is more common in young and middle-aged patients than in elderly patients and we see a higher incidence in males. Acute right-sided complex diverticulitis is rare. While non-surgical treatment is preferred for acute right-sided uncomplicated diverticulitis, no significant difference in outcome was observed between the three different treatments we compared. Resection and repair of diverticulum or abdominal drainage can also be used to treat patients with acute uncomplicated diverticulitis.

scholarly journals Characteristics of predominantly right-sided colonic diverticulitis without need for colectomy

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhi Chen ◽  
Bing Zhang ◽  
Dan Wu ◽  
Ye Jin
Keyword(s):  
Hospital Stay ◽  
Recurrence Rate ◽  
Sigmoid Diverticulitis ◽  
Colonic Diverticulitis ◽  
Abdominal Drainage ◽  
Female Ratio ◽  
Uncomplicated Diverticulitis ◽  
Significant Difference ◽  
Male To Female ◽  
Acute Colonic Diverticulitis

Abstract Background In China, diverticulitis is more often located in the right colon, mainly in the cecum and ascending colon. Here we study the characteristics of acute colonic diverticulitis and compare various treatments for acute right-sided colonic diverticulitis. Methods A retrospective analysis of 123 patients with acute colonic diverticulitis treated in our hospital from April 2013 to April 2020, including 114 cases of right-sided colonic diverticulitis, was performed. The characteristics of acute colonic diverticulitis were analyzed, and the therapeutic effects of different treatments for acute right-sided colonic diverticulitis were compared. Results 111 cases of caecal and ascending colonic diverticulitis were identified (90.2% of cases, male to female ratio 2.26:1, average age 39.6 ± 14.4 years, surgery ratio 24.3%, mean hospital stay 7.4 ± 4.3 days, recurrence rate 3.6%). Three cases of transverse colonic diverticulitis and three cases of descending colonic diverticulitis were found. Six cases of Sigmoid diverticulitis (4.9% of cases, male to female ratio 1:1, average age 67.7 ± 4.5 years, surgery ratio 33.3%, mean hospital stay 11.7 ± 5.5 days, recurrence rate 0%) were found. 13 patients underwent right-sided colonic diverticulitis resection and repair, while zero patients underwent colectomy. Abdominal drainage was performed in 15 patients with right-sided colonic diverticulitis. There was no significant difference in the length of hospital stay among the three treatments for right-sided colonic diverticulitis (P = 0.05). There was no significant difference in the recurrence rate among the three treatments of right-sided colonic diverticulitis (P = 0.358). While the recurrence rate of right-sided colonic diverticulitis was only 3.5%, relapse usually occurred within the first year following treatment. Conclusions In our patients, right-sided colonic diverticulitis is more common in young and middle-aged patients than in elderly patients and we see a higher incidence in males. Acute right-sided complex diverticulitis is rare. While non-surgical treatment is preferred for acute right-sided uncomplicated diverticulitis, no significant difference in outcome was observed between the three different treatments we compared. Resection and repair of diverticulum or abdominal drainage can also be used to treat patients with acute uncomplicated diverticulitis.

scholarly journals Neutrophil to Lymphocyte Count Ratio Has a Close Association With Severe Acute Colonic Diverticulitis in Patients Undergoing Surgical Treatment

2017 ◽  
Vol 102 (11-12) ◽  
pp. 514-521
Author(s):  
TaeHoon Kim ◽  
Tong Moon ◽  
Jin Yoon ◽  
SangSu Park ◽  
YongSeog Jang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Management ◽  
Lymphocyte Count ◽  
Acute Diverticulitis ◽  
White Blood Cells ◽  
Colonic Diverticulitis ◽  
Count Ratio ◽  
Co Morbidity ◽  
Acute Colonic Diverticulitis

Objective: To investigate the diagnostic potential of neutrophil-to-lymphocyte count ratio (NLCR) for acute diverticulitis. Summary of Background Data: We evaluated NLCR in patients with acute colonic diverticulitis who were treated with conservative and surgical treatments. Methods: A total of 205 patients who underwent surgical treatment or conservative management of acute diverticulitis between 2012 and 2016 were reviewed. Patients' age; sex; hospital days; co-morbidity; complication; period of use of antibiotics; treatment method; body temperature; and initial laboratory results such as neutrophil count, lymphocyte count, NLCR, and serum levels of C-reactive protein (CRP) were assessed. Results: The median ages of the conservative and surgical treatment groups were 46 and 68 years, respectively. Median CRP and glucose levels were high in acute colonic diverticulitis patients who underwent surgical treatment (P < 0.001, P < 0.001). Albumin level was low in the surgical treatment group (P < 0.001). NLCR was significantly different in both groups (conservative management vs surgical treatment, 4.1 mg/L versus 8.5 mg/L; P < 0.001). Median white blood cells was 11.36 × 109/L in the conservative management group and 14.0 × 109/L in the surgical treatment group, with no significance (P = 0.071). Multivariate analysis revealed that NLCR >10.21 [odds ratio (OR) = 5.613, P = 0.022]; CRP >17.23 mg/L (OR = 4.241, P = 0.006); and albumin ≤3.5 (OR = 4.192, P = 0.036) were significant for acute colonic diverticulitis patients. Conclusion: NLCR, CRP, and albumin levels were significantly associated with acute colonic diverticulitis in the surgical treatment group, and NLCR was the most powerful predictive marker of severe acute colonic diverticulitis.

EP.FRI.12Meta-analysis of demographic and prognostic significance of right-sided versus left-sided acute diverticulitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Neil J Smart ◽  
Andrew Maw
Keyword(s):  
Hospital Stay ◽  
Conservative Management ◽  
Emergency Surgery ◽  
Lower Risk ◽  
Length Of Hospital Stay ◽  
Colonic Diverticulitis ◽  
Co Morbidity ◽  
Male Patients ◽  
The Right ◽  
Acute Colonic Diverticulitis

Abstract Aims To compare the demographic and prognostic outcomes of right-sided versus left-sided acute colonic diverticulitis Methods We performed a systematic review in accordance with the PRISMA statement standards to identify all observational studies comparing demographic factors and outcomes of right-sided versus left-sided acute colonic diverticulitis. We used the ROBINS-I tool to assess the risk of bias of included studies. Random effects modelling was applied to calculate pooled outcome data. Results Analysis of 2933 patients from nine studies suggests that right-sided diverticulitis affects younger patients (MD:-14.16,P<0.00001) and more male patients (OR:1.33,P=0.02) compared with left-sided diverticulitis. Smoking (OR:2.23,P<0.0001), alcohol consumption (OR:1.85,P=0.002) and co-morbidity (OR:0.21,P<0.00001) were more common in patients with right-sided diverticulitis. The risk of complicated diverticulitis was lower in the right-sided group (OR:0.21,P=0.001). More patients in the right-sided diverticulitis group had modified Hinchey stage I disease (OR:10.21,P<0.0001) while more patients in the left-sided group had stage II (OR:0.19,P<0.00001), stage III (OR:0.08,P=0.009) or stage IV disease (OR:0.02,P<0.00001). Right-sided diverticulitis was associated with a lower risk of recurrence (OR:0.49,P=0.04), failure of conservative management (OR:0.14,P=0.0006), the need for emergency surgery (OR:0.13,<0.00001) and shorter length of hospital stay (MD:-1.70,P=0.02). Conclusions Right-sided acute colonic diverticulitis predominantly affects younger male patients compared with left-sided disease and is associated with favourable outcomes as indicated by the lower risk of complications, failure of conservative management, need for emergency surgery, recurrence, and shorter length of hospital stay. More studies are required to compare the postoperative outcomes in patients with right-sided and left-sided diverticulitis undergoing emergency surgery.

scholarly journals Comparison of Conservative versus Surgical Treatment Protocols in Treating Idiopathic Granulomatous Mastitis: A Meta-Analysis

Breast Care ◽  
2019 ◽  
Vol 15 (4) ◽  
pp. 415-420
Author(s):  
Fei Zhou ◽  
Lu Liu ◽  
Liyuan Liu ◽  
Lixiang Yu ◽  
Fei Wang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Recurrence Rate ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Breast Disease ◽  
Granulomatous Mastitis ◽  
Idiopathic Granulomatous Mastitis ◽  
Treatment Protocols ◽  
Significant Difference ◽  
Conservative And Surgical Treatment

Background: Idiopathic granulomatous mastitis (IGM) is a rare, benign breast disease without any definitive therapeutic strategy. It is controversial whether to use conservative or surgical treatment of IGM and high-level evidence-based medicine data are lacking. The purpose of this study was to systemically evaluate the clinical effectiveness of the conservative versus surgical treatment for IGM. Methods: In this meta-analysis, we searched PubMed, EMbase, ScienceDirect, and Web of Science for comparative studies about the conservative versus surgical treatment of IGM. Two researchers independently identified reports and extracted data. We used Stata 11 for data analysis. A meta-analysis was performed to investigate the differences in the recurrence rate of conservative and surgical treatment using a random effects model. Results: A total of 10 studies involving 1,101 patients were included. The results demonstrated that there was no significant difference in the recurrence rate among patients who were treated by nonsurgical therapy and surgical treatment. No publication bias was detected. Conclusion: This meta-analysis demonstrates that both the conservative and surgical treatment approaches have appropriate efficacy in IGM treatment and relapse. Further randomized controlled trials with longer follow-up periods are required to confirm the advantages of each approach.

scholarly journals Conventional incision and drainage versus incision and drainage with primary closure in acute abscess: a prospective study

2017 ◽  
Vol 5 (1) ◽  
pp. 281
Author(s):  
Amandeep Singh ◽  
Gurdhian Singh ◽  
Darsshan Singh Sidhu ◽  
Mohit Bhalla
Keyword(s):  
Wound Healing ◽  
Hospital Stay ◽  
Recurrence Rate ◽  
Conventional Method ◽  
Primary Closure ◽  
The Body ◽  
P Value ◽  
Incision And Drainage ◽  
Significant Difference ◽  
A Prospective Study

Background: An abscess is a common surgical condition. Abscesses may occur anywhere in the body. Surgical treatment of subcutaneous and soft tissue abscesses includes percutaneous aspiration, incision and drainage without primary closure, incision and drainage with primary closure with drain. The present study was planned to compare conventional method of incision and drainage with incision and drainage with primary closure in cases of acute -abscesses.Methods: A total of 100 patients with acute abscesses were included in the study and randomized into 2 groups with 50 patients in each group. The present study was carried out to compare the conventional method of incision and drainage with incision and drainage with primary closure of the wounds in acute abscesses with regards to wound healing, post- operative pain, duration of hospital stays and recurrence rates.Results: Wound healing was significantly faster in incision and drainage with primary closure (9.18±0.941days) as compared to conventional method of incision and drainage (16.66±1.944 days) [p <0.05]. Mean hospital stay with convention method of incision and drainage was 7.12±0.718 days and with primary closure was 4.0±0.728days (p <0.05). Mean VAS was significantly less in primary closure as compared with conventional method. Decreasing trend in VAS was observed on day 3, day 5 and day 7 (p value 0.000). Recurrence rate of an abscess was seen in 5 cases in conventional method and 2 cases in primary closure (p >0.05).Conclusions: Author have observed a significant difference noted in time taken for wound healing, postoperative pain, hospital stay and recurrence rate between two groups.

Risk Factors for Recurrence of Right Colonic Diverticulitis

2018 ◽  
Vol 36 (6) ◽  
pp. 509-513 ◽  
Author(s):  
Yeong-Chan Kim ◽  
Jun-Won Chung ◽  
Jeong-Heum Baek ◽  
Won-Suk Lee ◽  
Doojin Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alcohol Consumption ◽  
Hospital Stay ◽  
Recurrence Rate ◽  
Large Scale ◽  
Univariate Analysis ◽  
High Recurrence Rate ◽  
Time Interval ◽  
Colonic Diverticulitis ◽  
Risk Factors For Recurrence

Background: Right colonic diverticulitis (RCD) is more common in Asian countries than in Western countries, and the risk factors for recurrence of RCD are not fully understood. The objective of this study was to assess the risk factors for recurrence of RCD. Methods: We analyzed 296 patients admitted for treatment of RCD in the Gachon University Gil Medical Center from December 2001 to October 2014. Gender, age, BMI, obesity, hypertension, diabetes mellitus, alcohol consumption, smoking, Hinchey classification, and hospital stay were investigated as risk factors for recurrence. Results: Of the 296 patients with RCD, 31 patients recurred after conservative treatment. The median time interval between the initial episode and recurrence of diverticulitis was 10.4 months. In the univariate analysis, a high recurrence rate was observed in patients with a history of alcohol consumption, smoking, and long hospital stay. In the multivariate analysis, the recurrence rate was much higher (p < 0.001) in patients who stayed in the hospital for more than 10 days after the first attack. Smoking also elevated the recurrence rate (p = 0.011). Conclusion: Factors associated with recurrence of RCD may include smoking and the long hospital stay due to complexity when first diverticulitis occurs. Further prospective large-scale studies are needed to draw a definite conclusion.

Mechanical versus Chemical Pleurodesis after Bullectomy for Primary Spontaneous Pneumothorax: A Systemic Review and Meta-Analysis

2019 ◽  
Vol 30 (06) ◽  
pp. 490-496 ◽  
Author(s):  
Sarah Kher Ru Sim ◽  
Shireen Anne Nah ◽  
Amos Hong Pheng Loh ◽  
Lin Yin Ong ◽  
Yong Chen
Keyword(s):  
Hospital Stay ◽  
Recurrence Rate ◽  
Spontaneous Pneumothorax ◽  
Meta Analysis ◽  
Primary Spontaneous Pneumothorax ◽  
Systemic Review ◽  
High Recurrence Rate ◽  
Chemical Pleurodesis ◽  
Significant Difference ◽  
Observational Cohort

Abstract Introduction Primary spontaneous pneumothorax (PSP) and its high recurrence rate pose a therapeutic challenge to both patients and their managing surgeons. Mechanical or chemical pleurodesis can be used to prevent recurrence, but the optimal treatment often remains a matter of debate. This meta-analysis aims to compare the outcomes between mechanical and chemical pleurodesis following bullectomy for PSP. Materials and Methods Studies published up to 2019 were searched from Medline, Embase, Google Scholar, and Cochrane databases. A meta-analysis of randomized controlled trials (RCTs) and observational cohort studies (OCSs) comparing outcomes between mechanical and chemical pleurodesis for PSP was performed. Results Seven studies (one RCT and six OCSs) were included, comprising 1,032 cases of mechanical (799 abrasions, 202 pleurectomies, and 31 unspecified abrasions/pleurectomies/both), and 901 cases of chemical (643 talc, 69 minocycline, and 189 unspecified talc/kaolin) pleurodesis. The recurrence rate of pneumothorax after chemical pleurodesis (1.2%) was significantly lower than mechanical pleurodesis (4.0%) (pooled odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.59–5.67; p = 0.0007; I 2 = 19%). Hospital stay was also slightly shorter in the chemical pleurodesis group (pooled mean difference [MD] = 0.42 days; 95% CI = 0.12–0.72; p = 0.005; I 2 = 0%). There was no statistically significant difference in postoperative complications (pooled OR = 1.18; 95%CI = 0.40–3.48; p = 0.76; I 2 = 71%) and operative time (pooled MD = 3.50; 95%CI = −7.28 to 14.28; p = 0.52; I 2 = 99%) between these two groups. Conclusion Chemical pleurodesis is superior to mechanical pleurodesis following bullectomy for PSP in reducing hospital stay and recurrence rate. However, more RCTs with longer follow-up are necessary to demonstrate the benefit of chemical pleurodesis for PSP.

scholarly journals Routine antibiotics may not be needed to treat uncomplicated right diverticulitis: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0255384
Author(s):  
Kil-yong Lee ◽  
Jaeim Lee ◽  
Youn Young Park ◽  
Seong Taek Oh
Keyword(s):  
Propensity Score ◽  
Hospital Stay ◽  
Propensity Score Matching ◽  
Length Of Hospital Stay ◽  
Primary Study ◽  
Symptom Duration ◽  
Antibiotic Administration ◽  
Colonic Diverticulitis ◽  
Soft Diet ◽  
Significant Difference

We aimed to investigate whether antibiotic administration is necessary for patients with uncomplicated right colonic diverticulitis. Data from patients diagnosed with uncomplicated right colonic diverticulitis, who received inpatient treatment at a single center between January 2019 and January 2021, were retrospectively examined. The patients were divided into two groups according to whether antibiotics were administered. The patients were matched between groups using propensity score matching in a 1:1 ratio using logistic regression with the nearest-neighbor method. The primary study outcome was the length of hospital stay, and the secondary outcomes were time to the introduction of sips of water and a soft diet. The study included 138 patients who received antibiotics and 59 who did not. After propensity score matching, 55 patients were assigned to each treatment group. There was no significant difference between the two groups in terms of age (p = 0.772), sex (p>0.999), body mass index (p = 0.121), prehospital symptom duration (p = 0.727), initial body temperature (p = 0.661), white blood cell count (p = 0.688), or C-reactive protein level (p = 0.337). There was also no statistically significant difference in the length of hospital stay between the no antibiotic and antibiotic groups (3.1±0.7 days vs. 3.0±1.0 days, p = 0.584). Additionally, no significant difference was observed between the no antibiotic and antibiotic groups with respect to time to sips of water (2.1±0.7 days vs. 1.8±0.9 days, p = 0.100) and time to the introduction of a soft diet (2.4±0.8 days vs. 2.1±0.9 days, p = 0.125). The findings suggest that routine antibiotics may be not required for treating patients with uncomplicated right colonic diverticulitis.

scholarly journals A comparative study of Lichtenstein tension free hernioplasty with prolene hernia system hernioplasty for ingunial hernia

2019 ◽  
Vol 6 (10) ◽  
pp. 3581
Author(s):  
Shahaji Chavan ◽  
Harshad Gawade ◽  
Bhushan Shah ◽  
Akhil Kandarappa ◽  
Sunil Vishwanath Panchbha
Keyword(s):  
Hernia Repair ◽  
Hospital Stay ◽  
Recurrence Rate ◽  
Suitable Alternative ◽  
Tension Free ◽  
Myopectineal Orifice ◽  
Prolene Hernia System ◽  
Lichtenstein Hernia Repair ◽  
Significant Difference ◽  
Group Post

Background: Lichtenstein tension-free hernioplasty (LTH) has become the gold standard for hernia repair. It is easy to learn and perform with minimal complications and low recurrence rate. But it deals with only superior half of the myopectineal orifice. Prolene hernia system (PHS) hernioplasty is safe, causes minimal pain and has minimal recurrence rate but is still not popular due to high cost. The aim of the study is to compare the Lichtenstein tension-free hernioplasty with hernioplasty using prolene hernia system.Methods: A total of 60 patients with inguinal hernia were equally grouped into cases (PHS) and controls (LTH). Outcome measures were compared with regards to postoperative pain, hospital stay and complications.Results: There was no significant difference in mean days of post-operative hospital stay among cases and controls. On post-operative days 1 and 3, most of the patients experienced moderate pain and by 8th post-operative day most of the patients had no pain. The pain intensity decreased with increase in post-operative days. Seroma formation was seen among 2 (6.67%) cases (PHS) group in comparison to 3 (10.0%) controls (Lichtenstein) group. Post-operative wound infection was seen among 1 (3.33%) cases (PHS) group and controls (Lichtenstein) group each. Recurrence was seen neither among patients treated with either technique.Conclusions: Prolene Hernia System mesh repair could be a suitable alternative to time honored Lichtenstein hernia repair with added advantage of strengthening the whole of myopectineal orifice, and virtually eliminating any risk of recurrence. 

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