Comparison of prolene with parietex composite® mesh in laparoscopic intraperitoneal mesh hernioplasty for paraumbilical hernia.

Objective: To compare the outcomes of prolene macroporous mesh with Parietex Composite® mesh in patients undergoing Laparoscopic hernioplasty for management of Paraumbilical hernia. Study Design: Prospective Comparative study. Setting: Jinnah Hospital Lahore. Period: 1st January 2016 to 1st January 2018. Material & Methods: A total of 100 patients with diagnosis of Paraumbilical hernia, aged >18 years were included. There were two groups. In group A (n=50) prolene macroporous mesh (Covidien) was placed. In group B (n=50) Parietex Composite® mesh (Covidien) was placed. After hernioplasty all patients were followed for a period of 2 years for evaluation of primary procedure and any complications like seroma, hematoma and intestinal obstruction. Results: The mean length of stay was 2.74±2.13 days in group A, versus 2.23±1.25 in group B (p-value 0.15). Seroma formation was seen in 4 (8.0%) patients in group A versus in 02 (4.0%) patients in group B (p-value 0.40). Hematoma formation was seen in 01 (2.0%) patients in group A versus 0.0% patients in group B (p-value 0.10). There was no recurrence and intestinal obstruction in any group in two years follow up. Conclusion: There was no difference in surgical outcome and the complication between two groups of patients undergoing laparoscopic Paraumbilical hernia repair with prolene macroporous and Parietex Composite mesh. Moreover, parietex composite mesh are difficult to insert and much expensive. Therefore, prolene mesh can be safely used in patients undergoing Laparoscopic Paraumbilical hernioplasty.

The primary lumbar hernia with multiple defects: a rare case

Lumbar hernia is a rare entity of abdominal wall hernia. Due to varied presentation it poses a challenge in diagnosis and management to attending surgeon. The requirement of preoperative imaging and clinical examination has indispensable role in the diagnosis and surgical (open or laparoscopic) approach is the only treatment option. We are presenting a case of 44 year old male, diagnosed as lumbar hernia with multiple defects and successfully managed by laparoscopic mesh hernioplasty. The primary lumbar hernia is a rare entity that a surgeon may encounter once in his lifetime making it an interesting surgical challenge. The adequate knowledge of preoperative imaging and anatomy are indispensable. With advances in minimally invasive surgery, it can be applied to patients with lumbar hernia and management requires a more tailored approach. This condition can be managed by laparoscopic approach successfully.

Long Term Evaluation of Paraumbilical Hernioplasty by Onlay Technique

Objective: To evaluate long term results of paraumbilical hernioplasty by onlay technique. Material & Methods: This prospective study was started in Jan 2017 and completed in Oct 2021. A total number of 196 patients having paraumbilical hernia were included in the study by convenient sampling. Patients with recurrent, strangulated and obstructed hernia as well as patients with ulcerated skin over the hernia were excluded from the study. All the patients were operated under general anesthesia with muscle relaxants. A non-absorbable standard prolene mesh (15x15 cm or 30x30 cm) was used and fixed with prolene 3-0 suture. Redivac drain was used over the mesh for minimum of three days. After discharge, all the operated cases were advised to visit the outpatient department after one week, one month, three months, six months, one year and two years. Maximum follow-up was two years and minimum was one year to assess the long term complication including recurrence. Demographic data along with diagnosis, complication, were collected and analyzed with Excel 2019. Results: Total 196 patients were operated for paraumbilical hernia. From which 53 were male and 143 were female. Minimum age was 18 years old and oldest patient was 78 years old. Average age was 40.19± 10 years, median age was 38 years. Seroma was seen in 04 patients. Superficial wound infection was observed in 02 patient no deep-seated infection was reported in our study. During three months of follow-up, numbness was noted in 03 patients and 02 patients had pain at the operation site during manual work. After two years recurrence was observed in two female patients, who failed to control their weight. Conclusion: Paraumbilical hernia is very common presentation in female patients. In order to prevent complication of hernia like, incarceration, strangulation and obstruction, early repair of the hernia is recommended in all the cases. Onlay mesh hernioplasty is one of the safest techniques which is relatively easy procedure, has a short learning curve with promising results. It has a low recurrence rate. Keywords: Onlay Mesh hernioplasty, Paraumbilical Hernia, PUH.

A comparative study of Stoppa’s repair versus Lichtenstein technique for surgical management of bilateral inguinal hernia

Background: The surgical management of bilateral inguinal hernias has been a point of contention for a long time, particularly in terms of whether to repair them sequentially or simultaneously, especially following tension-free surgeries. The present study was planned to compare the outcomes of bilateral inguinal hernia repair between patients who underwent the Stoppa’s repair and those who underwent Lichtenstein tension free mesh hernioplasty repair.Methods: The study included all patients of both genders with age of 18 years with bilateral inguinal hernias. Patients with following any condition-a complicated inguinal hernia; an obstructed or strangulated inguinal hernia; a recurrent inguinal hernia; previous abdominal surgery; a local skin infection-were excluded from the study. Patients were randomised into 2 groups based on simple randomization-group 1: patients underwent Lichtenstein tension free mesh hernioplasty; and group 2: patient underwent Stoppa's repair.Results: The operative time was significantly shorter in group 2 patients as compared to group A. In both groups, there were no intraoperative complications. Group 2 patients had significantly lower postoperative pain scores measured by the visual analogue scale at 12 hours postoperatively, but there was no statistically significant difference in pain at 24 hours or 7 days postoperatively. Post-operative hospital stays, return to normal daily activities, and chronic groin pain, there was no statistically significant difference between the two groups.Conclusions: The present study was unable to show that either technique was superior in the treatment of bilateral inguinal hernias. Both procedures, on the other hand, were capable of achieving favourable postoperative outcomes and had similar problems.

Prospective study to evaluate the value of Identification of nerves crossing inguinal canal during inguinal mesh hernioplasty

Background Long-term morbidity associated with open inguinal hernia repair mainly consists of postoperative chronic pain. The mechanism responsible for the development of this postoperative pain is thought to be the entrapment, inflammation, and fibrotic reactions of the nerve around the mesh. Aim of the Work To analyse and provide comprehensive data on their incidence (identification rates), anatomical characteristics, and possible sources of heterogenecity, to decrease the risk of iatrogenic injury/ entrapment to these nerves during inguinal hernioplasty. Patients and Methods This study identified 40 patients who underwent inguinal hernia repairs with either routine repair or nerve identification and preservation. As several studies point out, a nerve-recognizing procedure is a logical step for minimizing postoperative groin pain. Such an approach can be advocated for two reasons: identification of the nerves for preservation or for performing standard neurectomy in case of interference with the position of the mesh. Results In the present study, there was no difference in pain scorings at one or 3-months after repair between different surgical techniques in patients undergoing open repair of a primary inguinal hernia. In present work, in addition to identifying and preserving all neural structures, specific maneuvers have been adopted for preventing postherniorrhaphy inguinodynia Conclusion The results indicated that routine nerve identification and preservation was associated with a significantly lower incidence of postoperative neuralgia compared with no nerve identification.

All in one meshplasty verses conventional open meshplasty in inguinal hernia in a tertiary care setup

Background: Inguinal hernia surgery has continued to evolve historically from tissue repair to the present tension free repair by using mesh. Various tension free mesh repair have been demonstrated throughout the years after lichten stiens tension free meshplasty but inguinodynia continues to be a problem with all hernioplasties. All-in-one mesh hernioplasty showed zero incidence of inguinodynia in 50 patients who underwent this novel procedure. The primary aim of the study was to compare between all in one meshplasty vs conventional open meshplasty in inguinal hernia in tertiary care setup.Methods: Our study was done in SRM Medical college and research center attached to SRM University in Kattankullathur, Chennai for one and half year. It was comparative study between all in one meshplasty verses conventional meshplasty. A sample size of 100 patients was the part of this study, out of which 50 underwent mesh fixation by all in one meshplasty and 50 patients underwent mesh fixation by conventional meshplasty.Results: All-in-one meshplasty can be considered superior to conventional meshplasty in view of incidence of post-op neuralgia, operative time, duration of stay in hospital.Conclusions: All-in-one meshplasty can be considered as a good replacement for conventional hernioplasty in inguinal hernia repair expecting lesser post-operative morbidity and a better quality of life post-operatively.

Mesh hernioplasty in emergency repair of traumatic abdominal wall hernia following bull horn injury

Traumatic abdominal wall hernia (TAWH) is uncommon, mostly following motor vehicle accidents, fall from height and bullfighting. Bullhorn injury, common in rural areas, presents as either penetrating injuries to the abdomen or blunt injuries leading to internal organs injury. Rarely the bull horn injury may lead to TAWH. We report a 70-year-old female from a rural area who suffered bull horn injury to the abdomen leading to TAWH without penetrating the horn and was managed in the emergency by an open mesh hernioplasty. We suture closed the 10×5 cm size defect and reinforced it with a polypropylene mesh of 15×15 cm in the emergency setting. The patient recovered well without any complications or recurrence and doing well at 1 year of follow-up. Mesh hernioplasty can be considered a feasible and safe option in the emergency repair of traumatic abdominal hernia following bull horn injury.

POS0422 PANNICULITIS AS A MANIFESTATION OF AN AUTOIMMUNE/AUTOINFLAMMATORY DISEASE

Background:ASIA syndrome or Schonfeld syndrome is an autoimmune/inflammatory condition induced by adjuvants in genetically susceptible individuals with the development of rheumatic diseases (RD), multiple sclerosis, sarcoidosis, and others.Objectives:to characterize the symptoms of panniculitis (Pn) associated with ASIA-syndromeMethods:Within 7 years, ASIA syndrome was diagnosed in 12 women, average age 37.2±7.4, with a referral diagnosis of “Erythema Nodosum” or “Panniculitis”. The duration of the disease was 16.7±3.9 months. In addition to general clinical study, the serum concentration of α-1 antitrypsin, amylase, lipase, ferritin, creatine phosphokinase (CPK), immunological parameters (ANP-Hep2, dsDNA, C3 and C4, CRP, ANCA, Scl-70, antibodies to cardiolipins G and M), computed tomography of the chest organs, pathomorphological and immunohistochemical examination of a biopsy specimen of skin with subcutaneous fat tissue (SFA) from the affected areas.Results:The development of ASIA syndrome was preceded by gluteoplasty using propantriol-1,2,3 (in 4 patients), liposuction (2), biorevitalization with hyaluronic acid (2) and endoprosthetics with breast implants (2), bone metal construction (1) and mesh hernioplasty (1). The clinical picture of Pn was characterized by generalized red-purple painful (VAS pain 55.8±17.3 mm) subcutaneous indurations on the upper limbs and trunk (in 100% of cases), face (16.6%) and lower limbs (33.3%), with ulceration and oily fluid leakage (58.6%). The saucer symptom was recorded in 83.3% of the observed patients. In 66.6% of cases, fever and articular syndrome were observed, in 41.6% – myasthenic syndrome and lymphadenopathy, in 8.3% – xerophthalmia, keratoconjunctivitis dry, xerostomia and recurrent parotitis. In blood tests, leukopenia (up to 2.0x109/l) was identified in 33.3% of patients, a significant increase in the level of creatinine phosphakinase – in 16,6%, a two or more times increase in ESR and CRP – in 100%. All patients demonstrated immunological changes. The morphological picture of the skin and SFA in 75% of cases resembled lobular Pn, in 8.3% – tumor lymphocytes with the immunophenotype of cytotoxic T-lymphocytes: CD3+, CD8+ were detected. The results obtained allowed confirming RD in 8 patients: systemic lupus erythematosus and idiopathic lobular panniculitis in 2 patients (respectively) and 1 in dermatomyositis, systemic scleroderma of Sjogren’s disease, mixed connective tissue disease. One case was diagnosed with sarcoidosis and T-cell lymphoma. In 2 patients after the liposuction procedure the course of Pn was reversible.Conclusion:Diagnosis of Pn associated with ASIA syndrome is a complex task that requires a multidisciplinary approach to verify the diagnosis and treatment tactics.Disclosure of Interests:None declared