A STUDY OF COMPARISON OF PURE TISSUE REPAIR (DESERDA) AND PROSTHETIC REPAIR (LICHTENSTEIN) METHODS FOR INGUINAL HERNIA REPAIR-A COMPARATIVE STUDY

INTRODUCTION: An ideal hernia repair should be tension free, tissue based, with no potential damage to vital structures, no long term pain or complications and no recurrence. Although Lichtenstein's prosthetic repair is simple and safe, but it is also correlated with risk of infections, recurrence, chronic pain, testicular atrophy and infertility, foreign body sensations and chronic groin sepsis. Desarda hernia repair does not require mesh and provide more physiological support. It is simple, easy to learn. AIMS AND OBJECTIVES: a) To compare the operative time, postoperative stay and time required to return normal activity between two groups. b) To compare early complication rate and late complication rate between two groups. MATERIALAND METHODS: This observational study was conducted among patients admitted with the diagnosis of primary inguinal hernia in SMIMER, Surat. The patients were randomly allocated to either Lichtenstein or Desarda method of hernia repair. Operating time, post operative stay and duration of return to normal activity were recorded. Early complications were noted and the patients were followed up to 12 months for late complications (chronic pain, foreign body sensation, and recurrence). RESULTS: The mean operative time and postoperative stay did not show signicant differ for both groups. Patients operated by Desarda technique returned to normal activity signicantly early by 12.2 ± 2.54 days as compared to patients operated by Lichtenstein techniques (14.0 ± 2.76 days, p = 0.01). Most common early complication in both groups was pain (D group; 40.0%, Lgroup: 45.2%) followed by wound infection (D group; 8.0%, Lgroup: 6.5%) and seroma (D group; 0.0%, Lgroup: 3.2%). Occurrence of chronic pain was more in Lgroup (58.1%) as compared to D group (16.0%, p=0.001). None of the patients from D group had foreign body sensation. Foreign body sensation was observed only in ve patients of Lgroup (16.1%). Recurrence rate during one year in Lgroup (6.5%) was higher than D group (4.0%). CONCLUSION: Early return to work was potential benet of Desarda repair. Early complications were similar in both procedures. Desarda repair has lower incidence of chronic pain and foreign body sensation. However, there is no signicant difference for chronic pain in Desarda group when compared in same patients operated bilaterally with different technique. This study was conducted with small sample size with short follow up. Therefore, result of late complication in the present study may insufcient to conclude the probability of occurrence as longer follow up and larger sample size is required.

Pharmacological stimulation of mesh implant engraftment after ventral hernia repair

Aim. To study the effect of pyrimidine medication hydroxyethyldimethyldihydropyrimidine on the systemic inflammation after prosthetic repair of the anterior abdominal wall hernia. Methods. We prospectively analyzed two groups of patients aged between 18 and 80 years, who underwent prosthetic repair of the aponeurosis defect in the anterior abdominal wall hernia with a standard polypropylene mesh implant. The main group (n=16) was given 0.5 g hydroxyethyldimethyldihydropyrimidine per os 3 times a day before meals for 57 days from the first day after the operation. In the control group (n=16), patients received basic therapy without hydroxyethyldimethyldihydropyrimidine. Results. The postoperative period in patients after elective prosthetic hernioplasty of anterior abdominal wall was associated with an imbalance of the immune system with a tendency to lymphocytopenia (count in blood changed by 27.0%; p=0.20, Wilcoxon criterion) without significant leukocytopenia (count in blood changed by 4.9%; p=1.00, Wilcoxon criterion) and an 82.8% increase in C-reactive protein content (p=0.2, Wilcoxon criterion) compared to baseline values before the surgery. The proposed pharmacological support of prosthetic hernioplasty of the anterior abdominal wall with hydroxyethyldimethyldihydropyrimidine allowed to correct the postoperative lymphocytopenia (p=0.04, U-criterion) and reduce the concentration of C-reactive protein by 223.6% (p=0.03, U-criterion) compared with the control, which was also associated with a decrease in the number of local complications of prosthetic hernioplasty. Conclusion. The use of hydroxyethyldimethyldihydropyrimidine in patients after prosthetic hernioplasty is associated with a significant decrease in the C-reactive protein level, prevention of postoperative lymphocytopenia and a decrease in the number of local wound complications; C-reactive protein level can serve as one of the early and significant indicators of postoperative complications in this category of patients.

THE NPWT USE IN PATIENTS WITH PURULENT COMPLICATIONS AFTER PROSTHETIC REPAIR OF ABDOMINAL WALL

Aim: to evaluate the prospects of using systems with negative pressure in purulent-inflammatory complications of prosthetic abdominal wall repair.Materials and methods: 51 patients were observed with purulent - inflammatory complications of prosthetic repair performed for abdominal wall hernias. Group I included 32 patients who developed an acute para-prosthetic inflammatory process (abscesses, phlegmon, infarction of the abdominal wall with infection, suppuration of the wound) up to 30 days after the intervention, group II included 19 patients with signs of chronic infection associated with with a previously implanted mesh (purulent fistulas, chronic abscesses of the abdominal wall). All patients underwent revision and debridement of the purulent site, if necessary, necrectomy, for some individuals complete or partial excision of endoprostheses, some patients used negative pressure therapy (NPWT), others performed only standard procedures generally accepted for purulent infection.Results: It was found that in individuals with acute inflammatory process (group I), the use of NPWT made it possible in all cases to preserve the network in situ. The need for repeated operations using this technology in acute surgical infection was significantly less (p = 0.00063, Fisher). The strength of the link between the risk factor (refusal to use NPWT) and the outcome (repeated intervention) is relatively strong (C = 0.514, Pearson, V = 0.599, Cramer). In a chronic purulent process, a decrease in the need for repeated interventions was not significant (Fisher, p = 0.26213), and the strength of the relationship between the risk factor and outcome was average (Pearson, C = 0.325, Cramer, V = 0.344).Conclusion: using of NPWT in chronic mesh infection involves partial excision of the endoprosthesis, and the possibilities of the technique require further study.

THE RESULTS OF THE ENDOVASCULAR PROSTHESIS IN PATIENTS WITH INFRARENAL AORTIC ANEURYSMS

An early and late results of endovascular prosthetic repair of the aorta were described. For 9 years, 71 patients with infra-renal aortic aneurysms underwent endovascular aortic prosthetics. In the early postoperative period, type II endoleaks were registered in 4,2 % of cases, and endoprosthesis branch thrombosis in 1,4 %. Systemic complications accounted for 2,8 %, with no hospital fatality. In the long-term period, the primary patency of shunts was 91,18 %. Endovascular aortic prosthetics is a safe and effective method of treating infra-renal aortic aneurysms, which demonstrates a low level of complications and mortality in the early postoperative period.