Comparison between modified rives procedure and bilayer mesh repair in management of large inguinoscrotal hernia and their effect on testicular volume and perfusion

To compare two different techniques in management of inguinoscrotal hernia with destroyed transversalis fascia of myopectineal orifice [Nyhus type III B and IV B and D], modified Rives procedure [MRP] and hilayer mesh repair [BMR] as regard: surgical problems, operative time, postoperative complications, hospital stay, effect on testicular volume [TV] and pcrfusion [TP] and recurrence rate. Patients -were divided into 2 comparable groups as regard age, BMI and type of hernia: I: 29 patients underwent MRP. II: 30 patients underwent BMR, preperitoneal mesh inserted through internal ring and onlay patch. US and CDUS were done to measure TV and peak systolic and end diastolic velocities and accordingly resistive index [RI] measured as indicator of TP. TP on hernial side was compared with healthy side preoperatively and with same side after one year. TV was measured postoperatively after one year. MRP was demanding and difficult especially in patients with BMI >30 and time consuming than BMR [111.24 +/- 16.42/87.8 +/- 15.96 min, P < 0.001]. BMR had less hospital stay [1.5 +/- 0.68/1.96 +/- 0.74 days, P = 0.016] but insignificant low postoperative morbidity than MRP. No recurrence in both groups after 2.42 +/- 1.007 and 2.48 +/- 0.95 y respectively. TP was impaired on hernial side preoperatively in both groups compared with healthy side [RI: 0.68 +/- 0.05 / 0.62 +/- 0.08, P - 0.0025 and 0.69 +/- 0.04 / 0.62 +/- 0.05, P< 0.001 respectively] and improved postoperatively [0.61 +/- 0.007, P < 0.001 and 0.62 +/- 0.07, P < 0.007 respectively]. TV was insignificantly affected [18.62 +/- 2.93 / 17.56 +/- 2.39 cm3, P= 0.762 and 18.38 +/- 2.641 / 16.57 +/- 2.51 cm3, P = 0.158 respectively]. On conclusion, BMR of Nyhus type III B and IV B and D is easier, and less time consuming than MRP. Both techniques are safe on testicles with improvement of TP postoperatively and economic

Tailored lateral internal sphincterotomy in management of chronic anal fissure with hypertonic internal anal sphincter. a modified minimal invasive technique and its clinical and manometric outcome

To do tailored lateral internal sphincterotomy extending up to upper end of fissure in patients having hypertonic internal sphincter [IAS] by technique has advantages of open and closed methods to keep continence. Clinical and anomanometric outcome will be assessed. 70 patients and 70 controls were subjected to anal manometric study. All patients had hypertonic IAS compared with controls. Sphincterotomy was done through 5-7mm perianal incision just lateral to lower edge of IAS. It extended up to upper end of fissure. Sentinel tags, anal polyps and fibrotic fissure were excised. Results were assessed as persistence of symptoms, complications, healing, postoperative resting anal pressure [RAP] and recurrence. Preoperative RAP significantly higher in patients [132.89 +/- 6.61 cm H2o] than controls [79.64 +/- 71, P >0.001]. Sepsis of sphincterotomy wound occurred in 1.4%, bruising in 1.4%, transient minor soiling in 11.4% and no incontinence. In 97.2%, fissures healed within 6 weeks, postoperative RAP dropped significantly [78.09 +/- 6.62 cm H2o, P >0.001]. After 15.8 months mean follow up period, recurrence occurred in 4.3%. tailored lateral internal sphincterotomy is effective treatment of CAF with anal hypertonia. Our technique is safe and does not affect continence