scholarly journals COMPLICATED INGUINAL HERNIAS;

2019 ◽  
Vol 26 (03) ◽  
Author(s):  
Naveed Akhtar ◽  
Syed Shams- Ul-Hassan ◽  
Muhammad Sabir ◽  
M. Nauman Ashraf

Background: Herniorrhaphy and hernioplasty are the two most common modalities used with different degree of success and complication rates in the treatment of inguinal hernia. Several studies show that use of mesh is superior to the non-mesh operations in inguinal hernia surgery.It is generally believed that the use of biomaterials should be limited to non-infected surgical fields.Now the concept regarding use of mesh in complicated hernias is changing as shown by many studies. Current study is being planned to observe the outcomes of the mesh hernioplasty in treatment of complicated inguinal hernias in emergency so that in future appropriate and safe technique may be suggested for repair of complicated hernias in emergency setting. Objectives: To compare the outcome of hernioplasty and herniorrhaphy in emergency for the treatment of complicated (Irreducible/obstructed) inguinal hernias regarding wound infection and hospital stay. Material & Methods:… Study Design: Randomized control trial. Setting: Surgical ward, Sheikh Zayed Hospital, Rahim yar khan. Period:09 months from 01-01-2016 to 30-09-2016. Sample Size: A total of 64 patients with 32 patients were included in each group, with confidence level of 95% and power of 80% and anticipated mean level of hospital stay in group 1 of 5±3.4 days versus 3±2.1 days in group 2. Sampling Technique: Non-probability, consecutive sampling. Results: In this study there were total 64 cases with 32 in each group. The mean age was 41.69±11.06 years and the mean duration of hernia obstruction was 12.83±4.97 hours. There was no significant difference in terms of age, duration of hernia and hernial obstruction between both groups. Seroma was seen in 5 (7.81%) out of 64 cases while wound infection was seen in 8 (12.50%) of cases. Seroma was seen in 2 (6.25%) out of 30 cases in herniorrhaphy as compared to 3 (9.38%) out of 32 cases with hernioplasty with p value of 0.64. Wound infection was seen in equally 4 (12.50%) out of 32 cases in both groups with p value of 1.0. Duration of hospital stay was 4.66±1.36 in patients with herniorrhaphy as compared to 4.53±1.37 days with hernioplasty with p value= 0.82. There was no significant difference in terms of age groups, duration of hernia and its obstruction between both groups regarding seroma. There was also no significant association among any of the confounding factors regarding the wound infection and length of the hospital stay between the both groups. Conclusion: We can perform hernioplasty as compared to herniorrhaphy for complicated inguinal hernia with similar complications and better success rates in the same emergency setting.

2020 ◽  
pp. 147-150

Introduction: Thyroidectomy is a common surgery in the neck area, in which the application of platysma muscle suture after thyroidectomy is still being discussed. This study was conducted to compare the application (currently common) or non-application of suture for platysma muscle. Methods: In this retrospective cross-sectional study, 117 patients underwent thyroidectomy, among which 63 cases without suturing platysma (control group) and 54 subjects with suturing platysma (Intervention group ) were examined in terms of postoperative pain based on visual analogue scale score measured 24 h post-operation. The samples were also investigated regarding hematoma and seroma, wound infection, length of hospitalization, scarring (1 year after surgery), duration of surgery, and the number of cases using opioids during the hospitalization. Patients with diabetes, previous neck surgery, coagulopathy, and radiation history were excluded from the study. The gathered data were analyzed statistically in SPSS software (version 18) using the Chi-square test and the Mann–Whitney U test. A p-value of less than (0.05) was considered significant. Results: Based on the findings, the mean age of the patients in the Intervention group was calculated at 51 years, of which 41 and 13 cases were females and males, respectively. In the Intervention group, 34 patients underwent complete thyroidectomy and 20 patients had hemithyroidectomy. The mean age score of subjects in the control group was calculated at 50 years, of which 44 and 19 patients were respectively female and male. No significant difference was revealed considering wound infection, length of hospitalization, created scarring, the amount of opioid use (opioids), and postoperative pain. However, only the length of surgery was different between the groups (P-value<0.05). Conclusions: There was no difference between wound and surgical complications and cosmetic results between both groups; nevertheless, due to the duration of the surgery and other benefits, such as consuming less thread, not suturing the platysma is recommended.


2017 ◽  
Vol 5 (1) ◽  
pp. 92
Author(s):  
Obaid Syed

Background: Ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent achieves this entire goal. The Lichtenstein mesh repair is associated with complications, postoperative dysfunction and high cost composite meshes. Desarda's technique, became a new surgical option for tissue-based inguinal hernia repair. The present study was designed to evaluate and compare the effectiveness and complications of the Desarda’s repair with Lichtenstein tension-free mesh repair for treatment of inguinal hernia in a developing country.Methods: 200 patients with unilateral, primary, reducible inguinal hernia were selected. Included patients were randomly divided into two groups. Studied parameters were Duration of surgery, intra operative complications, post-operative Pain, Duration of hospital stay, return to normal activities, post-operative complications and recurrences.Results: There were a total of 100 patients each group. There was no statistically significant difference in duration of surgery and complication rate between the two groups. Difference in mean VAS was not statistically significant. The mean hospital stay in Desarda’s technique was 2.5 days while it was 2.6 days in Lichtenstein’s group. The mean time to return to basic physical activity in the Desarda’s technique was 12.6 days while it was 13.3 days in the Lichtenstein’s group. There were no recurrences in either group. Chronic inguinal pain (>1month) was more frequent in Lichtenstein’s group.Conclusions: There is no significant difference in duration of surgery, intra operative complication rate, post-operative pain, complications and recurrence, between Desarda’s technique and Lichtenstein’s technique. However chronic inguinal pain is less in Desarda’s technique. Desarda’s repair must be considered in young patients (<30 years). Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up.


2018 ◽  
Vol 84 (11) ◽  
pp. 1774-1780 ◽  
Author(s):  
Bin Yang ◽  
Shengning Zhou ◽  
Yingru Li ◽  
Jianan Tan ◽  
Shuang Chen ◽  
...  

There remain concerns about the optimal technique for repairing recurrent inguinal hernias because of the high risks of complications and recurrence. The aim of this study was to compare Lichtenstein hernioplasty with the transabdominal preperitoneal (TAPP) laparoscopic technique in the treatment of recurrent inguinal hernias. One hundred twenty-two patients who underwent surgery for recurrent inguinal hernia were prospectively randomized to receive either Lichtenstein (n = 63) or TAPP (n = 59) hernioplasty between January 2010 and December 2014. Baseline characteristics, intraoperative complications, and short- and long-term postoperative factors were evaluated. Preoperative factors were comparable between the two groups. The average follow-up period was 46.2 ± 8.5 months. The two groups had similar intraoperative and short-term postoperative complication rates, whereas the rate of long-term postoperative complications was lower for the TAPP group than the Lichtenstein group (6.8% vs 23.8%, respectively, P = 0.012). The TAPP group had significantly lower visual analogue scale scores, fewer analgesics consumption, and faster recovery than the Lichtenstein group ( P < 0.05). Chronic pain was more prevalent in the Lichtenstein group than the TAPP group (15.9% vs 3.4%, respectively, P = 0.031). The recurrence rate was 4.8 per cent for the Lichtenstein group and 1.7 per cent for the TAPP group, with no significant difference ( P = 0.62). Both the Lichtenstein and TAPP procedures are safe and effective methods for repairing recurrent inguinal hernia with low incidence rates of life-threatening complications and recurrence. The TAPP procedure is superior to the Lichtenstein repair in terms of reduced postoperative pain, shorter sick leave, faster recovery, and better cosmetic results. Careful selection of the surgical procedures and implementation of technical essentials are necessary.


Author(s):  
Sahrish Bachani ◽  
Shahid N. Memon ◽  
Muhammad R. Pathan ◽  
Rehmat Sehrish Shah ◽  
Aneeta Kumari ◽  
...  

Background: Thyroid lobectomy is a common operative technique of management of benign solitary thyroid nodules in which drains are used routinely. Objective of this study to compare the outcome of thyroid lobectomies undergone with and without drains in patients of benign solitary thyroid nodules.Methods: A comparative cross-sectional research was completed on 98 patients of benign solitary thyroid nodules at surgery department of Liaquat University Hospital Jamshoro. Patients having age of 18-60 years underwent thyroid lobectomies were included and distributed in two groups A and B. Group A includes thyroid lobectomies with drain and Group B without drain. Postoperative outcomes including pain score assessed via visual analog score (VAS), hospital stay and complications including wound infection, seroma and hematoma.Results: Out of 98 cases, 49 underwent thyroid lobectomy with drain and 49 without a drain. Females patients were in majority in group A 42 (85.7%) and also in group B 47 (95.9%). No significant difference (p-value=0.674) was in mean age of group A 30.8±10.2 years and group B 31.8±12.2 years. Higher mean with significant difference (p-value=0.001) was in pain score of group A 5.61±1.25 as compared to group B 3.55±0.70. No significant difference was in complications; seroma 1 (2.04%) vs 5 (10.20%), hematoma 1 (2.04%) vs 1 (2.04%) and infection 3 (6.12%) vs 0 (0.0%) in group A and B respectively. Higher mean with significant difference (p-value=0.001) was in hospital stay of group A 2.40±1.57 days as compared to group B 1.42±0.54 days. No significant difference (p-value=0.748) was in overall rate of complications in group A 5 (10.20%) and B 6 (12.24%).Conclusions: Thyroid lobectomy with drain is not effective in lowering the postoperative complications whereas enhanced the risk of postoperative pain, wound infection and duration of hospital stay as compared to thyroid lobectomy without a drain.


Author(s):  
Tharun Ganapathy Chitrambalam ◽  
Koshy Mathew Panicker ◽  
Jeyakumar Sundaraj ◽  
Sidhu Rajasekhar ◽  
Pradeep Joshua Christopher

Introduction: Hernia surgery has evolved over a period of 2500 years from the Bassini-Shouldice era to conventional Lichenstein’s meshplasty to the laparoscopic era. Since, inception of the laparoscopic approach 25 years ago, there were several advancements in the techniques of inguinal hernia repairs. The two most commonly practiced laparoscopic approaches are the Total Extra Peritoneal (TEP) and Transabdominal Preperitoneal (TAPP) repair. Aim: To compare the outcomes for TEP and TAPP approaches in laparoscopic inguinal hernia surgery in terms of operative time consumed, postoperative pain, duration of hospital stay, complications and recurrence rate when performed by a single surgeon. Materials and Methods: A prospective interventional cohort study was carried out among 70 patients with uncomplicated inguinal hernia. Patients were divided equally into two groups of 35 patients and underwent TAPP and TEP repairs depending on group randomisation. All surgeries were performed by the same surgeon. Factors including operative time, postoperative pain, duration of hospital stay, complications and recurrence were documented and compared for both the groups. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 21. Unpaired t-test was used to compare the mean between the two groups. The p-value of <0.05 was considered to be statistically significant. Results: The mean operative time measured in minutes for TEP repair was 31.03 minutes and TAPP repair was 42.26 showing a difference of 11.23 minutes which was statistically significant (p-0.001). The mean Standard Deviation (SD) pain score at 24 hours for TEP repair was 2.43 (1.195) and TAPP repair was 3.43 (0.917). The mean (SD) pain score at 48 hours for TEP repair was 1.31 (1.051) and TAPP repair was 2.20 (0.901). The mean (SD) pain score at one week for TEP repair was 0.37 (0.690) and TAPP repair was 0.91 (0.781). The mean (SD) duration of hospital stay in TEP repair was 2.60 days (0.553) when compared to 3.49 days (0.658) in TAPP repair. All the results were statistically significant with a p-value of 0.001. Conclusion: TEP repair had superior outcomes in terms of reduction in operative time, less postoperative pain and shorter hospital stay than TAPP repair.


2019 ◽  
Vol 17 (3) ◽  
pp. 320-324
Author(s):  
Mahesh Bahadur Adhikari ◽  
Sumeet Karna ◽  
Kinju Adhikari ◽  
Atul Kasaju ◽  
Jagdish Lal Baidya

Background: Percutaneous nephrolithotomy has become the standard procedure for large renal stones but still remains highly challenging due to complications such as bleeding and sepsis, even though it has high stone free rate (SFR). We report the early outcomes of more than 1000 percutaneous nephrolithotomys done in our center.Methods: A retrospective study of all patients undergoing percutaneous nephrolithotomy from January 2010 to December 2017 in single institution was conducted. All cases were stratified into three groups based on tract size; standard percutaneous nephrolithotomy with tract size ? 22 F, mini percutaneous nephrolithotomy with tract size 15 – 20 F and ultramini percutaneous nephrolithotomy with tract size ? 14 F. Age, gender, stone complexity using Guy’s stone score, stone size, operative time, hemoglobin drop, hospital stay, early major and minor complications were reviewed.Results: A total of 1074 patients had undergone percutaneous nephrolithotomy among which, 578 patients were standard percutaneous nephrolithotomy, 433 mini percutaneous nephrolithotomy and 63 had undergone ultramini percutaneous nephrolithotomy. There was even distribution of patients with Guy’s stone score 1 and 2 in all three groups. However, majority of patients with Guy’s stone score 3 underwent standard percutaneous nephrolithotomy or mini percutaneous nephrolithotomy and no patients with Guy’s stone score 4 underwent ultramini percutaneous nephrolithotomy. Age group, gender and operative time were comparable between the groups; however, significant difference was noted in terms of less hemoglobin drop and shorter hospital stay (p-value < 0.05) in the miniaturized percutaneous nephrolithotomy group. Complications were found to be fewer in mini percutaneous nephrolithotomy and ultramini percutaneous nephrolithotomy group in comparison to standard percutaneous nephrolithotomy.Conclusions: Miniaturization of tract size significantly decreases post-operative complication rates, blood loss and hospital stay while maintaining high stone free rates in well selected patients undergoing Percutaneous nephrolithotomy.Keywords: Endourology; percutaneous nephrolithotomy; PNL; urolithiasis.


2014 ◽  
Vol 6 (2) ◽  
pp. 101-103
Author(s):  
De Reena ◽  
Sebanti Goswami

ABSTRACT Introduction The present study was done to compare nondescended vaginal hysterectomy (NDVH) and laparoscopically assisted vaginal hysterectomy (LAVH) with reference to indications, operative complications and outcome. Materials and methods This prospective longitudinal comparative study was conducted in the Department of Obstetrics and Gynecology, Medical College and Hospital, Kolkata, from November 2010 to October 2011. Judging the inclusion and exclusion criteria a sample size of 36 patients for NDVH and 31 patients for LAVH were selected randomly. The outcome of each surgical procedure was analyzed by standard statistical methods. Appropriate test of significance was applied (t-test) with p < 0.05 as level of significance. Results The mean duration of NDVH was 65 minutes and that of LAVH was 93.87 minutes. The difference was highly significant as p value was 0.000. The mean pain score analyzed by visual analog scale (VAS) in NDVH was 2.334 and 2.581. This was not statistically significant (p = 0.636). There was no significant difference in hospital stay in either group. Conclusion Laparoscopically assisted vaginal hysterectomy has the advantage of visualization of the pelvic structure from above and occasional dissection and adhesiolysis. But NDVH supersedes in its approach through the naturally created route, being faster, less expensive and results in a similar hospital stay and convalescence. How to cite this article Reena D, Goswami S. A Comparative Study of Laparoscopically Assisted Vaginal Hysterectomy and Non-descended Vaginal Hysterectomy. J South Asian Feder Obst Gynae 2014;6(2):101-103.


2017 ◽  
Vol 5 (4) ◽  
pp. 120-123
Author(s):  
Suman Kumar Shrestha

Background: Over the past years, several surgical techniques have been evolved, among which total extraperitoneal inguinal hernia repair is the laparoscopic technique which is more popular now.Objective: To evaluate the outcome of totally extra peritoneal laparoscopic hernioplasty in terms of operation time, hospital stay and complications.Methods: The prospectively designed descriptive study was carried out at Department of Surgery Unit III, Kathmandu Medical College Teaching Hospital from February 2014 to April 2015. Forty seven consecutive patients above 15 years of age underwent totally extra peritoneal repairs for inguinal hernias. The selection criteria were reducible primary or recurrent, unilateral, direct and indirect inguinal hernias. All the relevant details of each patient were noted subsequently and analyzed statistically using Statistical Program for Social Sciences (SPSS) version 15.Results: The mean age of patient was 49±2.5 years. The mean operation time was 65±5.3 minutes. There were no serious complications except four (8.5%) cases of groin seroma which resolved after single time aspiration. Three (6.3%) cases had developed recurrence, two (4.2%) had developed hydrocele in a median follow up period of 6±1.5 (range, 3-9months). The mean inpatient hospital stay was 1.7±0.2 (range, 1-2.4days).Conclusion: Total extra peritoneal hernioplasty is safe and feasible with acceptable complications and recurrence rates.Journal of Kathmandu Medical College, Vol. 5, No. 4, Issue 18, Oct.-Dec., 2016, page: 120-123


2017 ◽  
Vol 4 (5) ◽  
pp. 1672
Author(s):  
Mir Mujtaba Ahmad ◽  
Raja Nadeem ◽  
Musharraf Husain ◽  
Irfan Nazir ◽  
Manzoor Ahmad

Background: Haemorrhoids or ‘Piles’ is a frequently observed disease in surgical practice. Various non-surgical and surgical treatments are available. Open haemorrhoidectomy (Milligan-Morgan) is a widely-used procedure. A recent novel technique called ‘Stapled haemorrhoidopexy’, first described and performed by Italian surgeon Antonio Longo is gaining worldwide recognition for its benefits.Methods: A total of 155 patients between the age group of 20 and 65 years, diagnosed to have grade III or IV haemorrhoids were included in the study, divided into 2 groups, Group 1 undergoing Open haemorrhoidectomy (30 patients) and Group 2 undergoing Stapled haemorrhoidectomy (25 patients). Post operatively patients of both groups were reviewed at the time of discharge, at 7 days after discharge, at 1 month and 3 months post-surgery. The significant difference of the percentages between the two groups was tested using the Chi Square test. The significant difference in the mean values between the 2 groups was tested using the Student’s t- independent test. For all the tests, level of significance was taken as 0.05.Results: In present study, the mean operating time for stapled haemorrhoidopexy was 34.96±7.38 minutes with an average of 20-50 minutes, while with open haemorrhoidectomy, the mean operating time was 44.67±11.83 minutes (p<0.001). The mean VAS scores at 6, 12 and 24 hours with stapled haemorrhoidopexy were 1.79±0.76; 1.83±0.61 and 1.47±0.66, respectively, and with open haemorrhoidectomy, the mean VAS scores at 6, 12 and 24 hours were 2.88±0.88; 2.13±0.82 and 1.91±0.83, respectively. The mean hospital stay for patients with stapled haemorrhoidopexy was 1.96±0.55 days in comparison to the open group where the mean hospital stay was 3.51±0.72 days (P-value<0.001). The time for resumption to routine work was shorter in stapled group 8.61±2.76 as compared to 15.34± 2.12 which was statistically significant (P value <0.001). The mean amount of blood loss during stapled hemorrhoidectomy was statistically less than in open surgery.Conclusions:Stapled Haemorrhoidectomy is less painful with shorter duration of hospital stay and resumption of daily activity is faster than the open haemorrhoidectomy. However, long term follow-up is required to know the recurrence rate in stapled haemorrhoidectomy. 


2019 ◽  
Vol 26 (09) ◽  
pp. 1434-1439
Author(s):  
Shehla Usman ◽  
Aneela Zareen ◽  
Aimun Gillani ◽  
Ammara Kaleem ◽  
Mohsin Ali ◽  
...  

Background: Bronchiolitis is an acute inflammation of bronchioles that can be severe enough to require admission in intensive care unit. There are multiple modalities used for treatment of bronchiolitis. The objective of this study was to compare the response of adrenaline and salbutamol nebulization in terms of clinical improvement and duration of hospital stay. Study Design: Randomized controlled trial. Setting: Pediatrics Department of Avicenna Medical College and Hospital, Lahore. Period: March 2018 to October 2018. Methods: Total 66 patients with 33 in each group between ages of 2-months to 3-years admitted with the diagnosis of bronchiolitis, were included in the study. Children in the group 1 were patients treated with salbutamol nebulization 0.15 mg/kg with 3 ml normal saline every six hourly. Children in the group 2 received adrenaline nebulization 0.1 ml/kg of 1:1000 dilutions with 3 ml normal saline every six hourly. Both the groups were given similar supportive management that included oxygen therapy, intravenous fluids, and antipyretics. Data was collected in the form of age, gender, heart rate, respiratory rate, SpO2 and RDAI score at admission, 6hr, 24 hr and 48hr after admission, duration of hospital stay and duration of oxygen therapy. Results: Out of 66 patients, 38(57.6%) were male and 28(42%) were female. The mean with standard deviation of age in months was 20.45 + 12.9 in salbutamol group and 16.7 + 12.3 in adrenaline group (p value = 0.23). Mean with standard deviation of weight of patients was 9.7+ 3.5 in salbutamol group and 8.9+3.3 in adrenaline group (p value =0.34). Regarding the duration of hospital stay the mean and standard deviation of hospital stay was 4.2+ 0.9 in salbutamol group and 3.9 + 1 in adrenaline group with p value 0.016.  Mean and standard deviation of duration of oxygen therapy was 1.05+ 0.7 in salbutamol group and 0.9+0.4 in adrenaline group with p value 0.42. There was no significant difference in the values of RDAI, heart rate, respiratory rate, SPO2 at admission and subsequently after 6hrs, 24hrs, and 48hrs. Conclusion: We concluded that there was a significant reduction in duration of hospital stay in patients who received adrenaline nebulization then those nebulized with salbutamol. RDAI scores in the initial 48 hours in both the groups were improved in successive readings, but there was no significant difference in RDAI scores between the two groups recorded at different time intervals.


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