Effect of elective division of the ilioinguinal nerve during open mesh repair for inguinal hernia on chronic post - hernioplasty pain

The present study included 73 repairs in 66 patients with a median age of 42 years. All patients were managed by Lichtenstein open MeSH repair. Thirty-five repairs included ilioinguinal nerve preservation [group I] and 38 repairs included elective division of the nerve [group II]. Chronic pain [pain for six month or more after operation] was present with four repairs in group I and one repair in group II. The neuropathic type of pain occurred in two patients of group I but not in group II. One patient in group I could not characterize the pain and another had testicular pain. Patients of group II had somatic pain. For both groups, chronic pain was more common in younger patients and in those with preoperative symptomatic [painful] hernias. Numbness was common in both groups

Core fistulectomy with transanal rectal mucosal advancement flap for the treatment of suprasphincteric and high trans - sphinteric fistula in ano

In this study, 19 patients [16 males and 3 females, mean age of 36 years]with suprasphincteric and high trans-sphincteric fistulae of cryptogenic origin were managed by core fistulectomy and rectal mucosal advancement flap. Three patients had recurrent fistulae and two of them had mild degrees of incontinence preoperatively. At one year follow up, recurrence occurred in two patients and deterioration in the preoperative continence occurred in two patients. Flap retraction occurred in one patient and minor technical problems in another two patients in the form of flap tip necrosis and subflap hematoma; all with no consequences as regards recurrence and incontinence

Early gastrografin follow-through study in adhesive small bowel obstruction can predict the need for surgery and improves the outcome

Controversy exists about the management of adhesive small bowel obstruction [SBO] in absence of strangulation. Usually, surgery is reserved for failed trial of conservative treatment but the optimum duration of this trial is not well defined. Complete SBO always progresses to intestinal ischemia and ultimately will need surgery. Incomplete SBO usually responds well to conservative management. Therefore, early differentiation between the two types of SBO would help in early prediction of the need for surgery. In the present study, 24 hour follow-through Gastrografin radiography was used for this purpose. The study included 47 patients presenting with picture of simple adhesive SBO [without strangulation] divided into two groups. The Gastrografin group included 24 patients and the control group included 23 patients. In the Gastrografin group, surgery was decided upon the 24 hour Gastrografin radiograph followed by persistent failure of contrast reaching the colon after another 24 hour follow-up. In the control group, surgery was decided upon failure of conservative-management after 5 days trial. Development of strangulation signs at any time was an indication for urgent operation. In the Gastrografin group, the 24 hour follow-through radiograph diagnosed complete SBO in 6/24 patients [25%]. All 6 patients had persistent failure of contrast reaching the colon after another 24 hour follow-up and were subjected to surgery and complete obstruction was confirmed operatively in all. The 18 patients diagnosed with incomplete obstruction by the 24 hour radiograph were all successfully managed conservatively. The predictive value of the Gastrografin 24 hour follow-through radiograph in differentiating between complete and incomplete SBO was 100%. Surgical exploration was needed in 6/23 patients [26%] in the control group and complete obstruction was confirmed in all. In the explored patients, bowel resection for ischemia was done in 2/6 patients [33%] in the control group but 0/6 patients [0%] in the Gastrografin group [P<0.05]. Post-operative complications [ileus and ascitis with hypoalbuminemia occurred in 2/6 patients [33%] in the control group but in 0/6 patients [0%] in the Gastrografin group [P<0.05]. The mean time between hospital admission and operation was 2.3 days in the Gastrografin group and 6.5 days in the control group [P<0.05]. The overall mean hospital stay was 5.6 +/- 1.1 days in the Gastrografin group and 7.4 +/- 2.3 days in the control group [P>0.05] but among the surgically explored patients, the mean hospital stay was 8 +/- 1.2 days in the Gastrografin group and 13 +/- 2.9 days in the control group [P<0.05]. In conclusion, the early use of Gastrografin follow-through study in patients with simple adhesive SBO is safe and allows earlier surgical intervention and hence reduction of complications due to surgical delay. The 24 hour follow-through radiograph is reliable in predicting patients who will benefit from conservative treatment and those who need surgery

Ultrasound guided percutaneous drainage versus surgical management in hepatic hydatidosis: a prospective, randomized study

To compare the safety and efficacy of percutaneous drainage with those of surgical cystectomy, the traditional treatment of hydatid disease of the liver. In a prospective study, we randomly assigned patients with hepatic hydatidosis Gharbi types I, II and III to treatment with ultrasound guided percutaneous drainage [16 patients] and cystectomy [15 patients]. Albendazole [10 mg per kilogram of body weight per day for eight weeks] was administered to the patients of both groups. Patients were serially assessed by clinical and ultrasonographic examinations, and hydatid serologic tests. The cyst diameter did not differ significantly between the two groups [P= 0.20]. At 6 month follow-up, the mean cyst diameter decreased from 10.4 +/- 3.7 to 3.4 +/- 1.5 cm [P<0.001] after percutaneous drainage and from 9.4 +/- 4.1 to 1.8 +/- 0.9 cm [P<0.OOl] after surgery. The mean hospital stay was 6.2 +/- 1.2 days in the drainage group and 12.4 +/- 3.5 days in the surgery group [P<0.00l]. Over a mean follow-up period of 12 +/- 3 months in the drainage group and 10 +/- 2 months in the surgery group, complete cyst healing [sonographically evidenced cyst death] occurred in all patients of both groups. The cysts disappeared in 13 patients [81%] in the drainage group and in 11 [73%] in the surgery group [P 0.29] and were replaced by solid echo pattern in 3 patients [19%] in the drainage group and in 4 patients [27%] in the surgery group.. After an initial rise in 3 patients of the drainage group and 2 patients of the surgery group, the echinococcal-antibody titers fell progressively and at the last follow-tip were <1:160 in 15 patients [94%] of the drainage group and 13 patients [87%] of the surgery group. There were procedure-related minor complications in 5 patients [3 1%] in the drainage group and 3 patients [20%] in the surgery group. No recurrences occurred in both groups during follow-up. Percutaneous drainage, combined with albendazole therapy, is an effective and safe alternative to surgery for the treatment of most types of hydatid cysts of the liver and requires a shorter hospital stay

Simple suture closure versus suture closure with mesh enforcement for repair of small primary ventral incisional hernias. A randomized prospective study

In this study, simple suture closure [group I, 26 patients] was compared with onlay polypropylene MeSH enforcement [group II, 27 patients] for defects less than 7 cm in their maximum dimensions providing the absence of persistent predisposing factor for herniation. The largest defect was 6.5 cm and the smallest was 2.5 cm. The patients were followed up for one year postoperatively. For females who became pregnant, the follow up was extended to six months after delivery. In conclusion, MeSH repair was recommended for primary incisional hernias with musculo-aponeurotic defects larger than 4 cm. If unplanned pregnancy during the first postoperative year is possible, MeSH repair is recommended regardless of the size of the hernial defect