Comparison of Post-Operative Complications Between Sublay and Onlay Mesh Repair in Incisional Hernia

Objective: To compare the post-operative complications between sublay and onlay mesh repair in incisional hernia. Materials & Methods: This randomized controlled trial was conducted at Department of Surgery, Sandeman Provincial Hospital Quetta from May 2019 to November 2019. Total 250 patients with incisional hernias for more than 3 months, having age 20-40 years either male or female were selected. Then selected patients were placed randomly into two groups i.e. Group A (Sublay group) & Group B (Onlay group), by using lottery method. Patients were called for follow up 15th day for post-operative complications in term of wound infection and seroma formation. Results: The mean age of patients in group A was 34.73 ± 4.32 years and in group B was 34.51 ± 4.67 years. Out of these 250 patients, 161 (64.40%) were female and 89 (35.60%) were males with female to male ratio of 1.8:1. Wound infection was seen in 07 (5.60%) patients in group A (Sublay technique) and 17 (13.60%) patients in group B (Onlay technique) with p-value of 0.033. Seroma formation was seen in 09 (7.20%) patients in group A (Sublay technique) and 26 (20.80%) patients in group B (Onlay technique) with p-value of 0.002. Conclusion: This study concluded that rate of wound infection and seroma formation is less after sublay mesh repair for incisional hernia as compared to onlay repair. Keywords: Hernia, incisional, onlay, sublay, seroma.

Ensemble stacked approach incorporated into automated machine learning predicts the risk of surgical site infection after complex instrumental spinal surgeries

Automated machine learning is explored to develop risk models predicting surgical site infections and adverse events including seroma formation after complex spinal surgeries.

The Effect of Quilting Sutures on the Tension Required to Advance the Abdominal Flap in Abdominoplasty

Background Quilting sutures attaching the abdominal flap to the aponeurosis contribute to the prevention of seroma formation post-abdominoplasty. The sutures distribute the tension over the subcutaneous tissue along the flap length, theoretically decreasing tension at the distal (cutaneous) end of the flap. This is expected to reduce the risks of necrosis, dehiscence, and enlarged or hypertrophic scars. Objectives The study sought to verify whether quilting sutures decrease the tension required to advance the dermal-fat flap in abdominoplasty. Methods Thirty-four women undergoing abdominoplasty with quilting sutures participated in the study. The tensile force required for flap advancement was measured before and after the placement of quilting sutures, using a digital force gauge, and then compared. Differences in tensile force were tested for correlations with body mass index (BMI), age, weight of flap tissue removed, number of previous pregnancies, and postoperative complications, including seroma formation, hematoma, necrosis, dehiscence, and enlarged or hypertrophic scars. Results A mean reduction in tension of 27.7% was observed at the skin suture after the placement of quilting sutures (p < 0.001). No significant correlation was found of reduced flap tension with BMI, age, weight of tissue removed, and number of births. A case of seroma formation and two cases of enlarged scars were observed, but no case of hematoma, necrosis or wound dehiscence was detected. Conclusions The use of quilting sutures to attach the abdominal flap to the aponeurosis of the anterior abdominal wall reduced tension at the advancing edge of the flap in abdominoplasty.

Role of Tranexamic Acid for Seroma Prevention in Obese Patients Undergoing Laparoscopic Ventral Hernia Repair Under Spinal Anesthesia

Objective: The aim of this study is to determine the effectiveness of tranexamic acid for seroma prevention in obese patients undergoing laparoscopic ventral hernia repair under spinal anesthesia. Study Design: Cross sectional study Place and Duration: Jinnah Postgraduate Medical Center (JPMC) Karachi, 1st July 2020 to 30th June 2021. Methods: There were one hundred and ten patients f both genders had abdominal hernia were included in this study. We have taken written consent from all the patients for detailed demographics age, sex and body mass index. Patients were undergone for laparoscopic ventral hernia repair under spinal anesthesia in OPD. The size and contents of the defect were determined by an abdominal and pelvic ultrasound. All patients received postoperative tranexamic acid. Drains were put in to measure the amount of seroma that was produced as a result of the procedure. SPSS 22.0 was used to analyze all of the data. Results: 42.23±6.55 years were the mean age of the patients. Mean Body mass index was 32.13±3.43 kg/m2. Majority of the patients 74 (67.3%) were females and rest of the patients 36 (32.7%) were males. In 91 (82.7%) cases seroma reduction was calculated within week. Only 41 of the 110 patients had drain output of less than 150 ml, 55 had drain output of 150-300 ml, and 14 had drain output greater than 300 ml. Seroma formation was found among 7 (6.4%) cases. Conclusion: Tranexamic acid was found to be efficient in minimizing postoperative seroma formation in ventral hernia repairs, according to the findings of this study. Keywords: Laparoscopic, Tranexamic acid, Plasminogen, Seroma, Obese Patients

Comparative study between Single incision versus two separate incisions in conservative breast surgery and axillary clearance

Background Single incision technique is an oncoplastic surgery aimed to remove both the breast tumor and axillary clearance through one incision, thus providing better aesthetic results than the conventional breast conservative two incision technique. However this procedure is more difficult, since visualization and the resection space are limited, demanding greater experience from the surgeon. Objective To compere between single incision in excising upper outer breast tumor and axillary clearance versus two separate incisions in conservative breast surgery as regard cosmetic outcome, seroma formation and time needed for drainage for both breast and axilla. Patients and Methods This is a prospective cohort study to compere between single incision in excising upper outer breast tumor and axillary clearance versus two separate incisions in conservative breast surgery as regard cosmetic outcome, seroma formation and time needed for drainage for both breast and axilla. Results Single incision resulted in only one small scar and provided feasible breast cancer treatment with excellent acceptance and satisfaction by the patients. Double incision on breast and axilla is associated with lower rate of long-term postoperative lymphedema and minimizing disruption of axillary lymphatic and vascular channels. Conclusion The single incision technique was shown to be providing better cosmetic result but more seroma formation. With the confirmation of oncologic and surgical efficacy, future areas of study will include long term evaluation of patient oncologic, functional, and cosmetic outcomes following the single incision approach.

Mastoid Dressing in Ear Surgery: Is it Still Relevant?

Introduction Mastoid dressings are conventionally used in patients who undergo Tympanoplasty using post auricular approach. The rationale behind using a mastoid dressing is that the said dressing prevents haematoma formation and acts as a protective covering during the post-operative period. This study aims to understand the significance of mastoid dressing in patients undergoing Cortical Mastoidectomy and Tympanoplasty and its role in preventing post-operative wound complications and patient comfort. Materials and Methods A total of 77 patients were enrolled in the study over a one year period and were randomised into dressing and no dressing groups with the aim of deciphering any advantage of the mastoid dressing over a smaller dressing. Results Our data revealed no added advantage of conventional mastoid dressing over a small gauze piece dressing in terms of haematoma/seroma formation, contusion and wound dehiscence. However, there was significantly reduced patient discomfort and sleeping difficulties post-operatively in the no dressing group. Conclusion We conclude that smaller dressing is more favourable than the bulkier conventional mastoid dressings.