rimmed prolene mesh in ventral hernioplasty: a novel configuration for a better pro-peritoneal application

The development of abdominal wall defects is remarkable in surgical practice. Therefore, trials are never stopping to improve the methods of repair of such defects. Tension-free repairs using prosthetic materials are highly recommended, as long as a durable reconstruction is desirable. Debate always exists as regards the best prosthetic material; however polypropylene is the most commonly used one. Polypropylene mesh implants are available in many designs, configurations, thicknesses of weaves and strands, and sizes of pores. Is to revive the valuable sublay positioning of the prolene mesh by presenting a novel configuration of the mesh "rimmed prolene mesh", which is supposed to facilitate its application in the pro-peritoneal space, with comparison of the results to those of the commonly used onlay technique. Eighty nine patients with ventral hernia were enrolled into the study, during the period between January 2004 and October 2006. Seventy five cases were females, and 14 were males. They were randomly allocated between two groups of management, [A] and [B]. Group [A] was formed of 44 patients with a mean age of 40 years [30-57]. In this group, pro-peritoneal [sublay] rimmed prolene mesh [RPM] ventral hernioplasty was done. Group [B] included 45 patients with a mean age of 42 years [32-54]. This represented the cotrol group in which the common procedure of pro-parietal [onlay] flat mesh hernioplasty was applied. The method of preparation of the rimmed mesh and the technique of its application are described. Intra-operative and postoperative findings were recorded for both groups, and the results were compared. The presence of the rim configuration of the mesh had the following benefits in the pro-peritoneal application: It allowed fixation of the mesh to the edge of the fascial defect and obviated the need to close the defect over the mesh as in Rives Stoppa technique. Consequently, this insured a more tension-free repair. The 3-5 mm-height rim made it easier and faster to take the bites in the mesh during its fixation to the facial defect. The height of the rim also obviated the need to dip the needle down into the mesh that overlies the peritoneum, thus avoiding any event of a suture entangling a bowel loop, thus adding an element of safety. Otherwise, the comparison of results of the two groups of cases revealed shorter operative time and hospital stay in group A compared to B, being 92 [60-140] minutes and 1.86 [1-3] days for group A and 120 [75-180] minutes and 2.97 [4-9] days for group B. The overall rate of complications was also less in group [A], particularly the incidence of seroma. No recurrence was encountered in either group till the end of October 2006. The rimmed prolene mesh [RPM] is a novel configuration for a simple, rapid, efficient and safe pro-peritoneal application in treatment of ventral hernia. Further trials of application of the RPM are recommended to evaluate its effectiveness. A ready-made RPM may then be available, allowing its use at a wide scale

Comparative study between insufflation and gasless S.E.P.S. techniques

Different techniques have evolved for subfascial endoscopic perforator surgery [SEPS] using either the concept of CO 2 insufflation or the gasless concept. In this prospective comparative randomized study, the gasless technique using a novel space maker self retaining endoscopic viewer [SSEV] was compared with the insufflation SEPS regarding technical simplicity, efficacy and safety. Twenty -four patients [19 males, 5 females] with a mean age of 40 years [range: 26- 54] were randomized between group A [13 patients, 15 limbs] in whom Co, insufflation was used and group B [11 patients, 13 limbs] in whom gasless SEPS technique was chosen with the aid of a space maker self retaining endoscopic viewer [SSEV]. Limb exanguination and tourniquet application was not needed at all in gasless SEPS technique [group B]. Also, space collapse, loss of orientation and abortion of the technique was not encountered. The operative time was shorter than in group A [28 +/- 12 minutes for group A and 15 +/- 9 minutes in group B]. In gasless SEPS, haematoma was not reported. However, mild wound infection and missed perforators were found in 3and2 limbs [23.07% and 15.38% respectively] and ulcer recurrence in 4 limbs [30.76%]. Compared to the insufflalion SEPS technique, the gasless SEPS technique stands as an easier and safer technique with comparable efficiency. Is obviates the need for limb exanguination and the use of tourniquet and keeps the optical field and orientation in the subfascial plane all-through the procedure without collapse or disorientation

Duplex guided endo-luminal radiofrequency ablation of the varicosed great saphenous vein "an old technique using the avalible new technology"

Endo-luminal radiofrequency ablation [RFA] has been proposed as a minimally invasive alternative for treatment of refluxing great saphenous vein. The aim of the study is to evaluate applicability and efficacy of duplex guided endo-luminal radiofrequency ablation of the varicosed. great saphenous vein using the available technology and comparing this with the gold standard treatment. Over two years, forty-three patients with primary great saphenous vein varicosities had been selected and randomly divided info two groups; group A [20 patients, 26 limbs] who were planned for sapheno-femoral disconnection and endoluminal radiofrequency [RP] ablation of their great saphenous vein varicosities and group B [23 patients, 30 limbs] who were subjected to sapheno-femoral disconnection and stripping: The RF ablation in this study using a special catheter was done by open technique through one groin crease incision without intraoperative bleeding, postoperative haematoma or ecchymosis. Thermal skin and saphenous nerve injury and superficial thromb-phlebitis were encountered in 2 limbs [7.69%], clinical and duplex recurrence in 3 limbs [11.54%], and cord like sensation in 6 limbs [23.07%]. Endovenous RF obliteration is more expensive, but the patients recovered faster and had significantly shorter sick leaves [3-7 days] than those in the stripping group [7-15 days]. Endovenous radiofrequency ablation using the available technology is effective in eliminating the great saphenous vein from the venous circulation with faster recovery and better cosmetic results than surgical stripping, yet it is still costy and has some adverse effects

Evaluation of the usefulness of quadruple test in preoperative diagnosis of indeterminate breast masses

It is always a challenge to the physician to diagnose clinically the nature of a breast mass; especially with the increasing desire among patients to avoid surgery just for accurate diagnosis. Clinical examination of the breast, mammography, ultrasound supported by FNAC, provide a high level of diagnostic accuracy. This study included 45 female patients with 50 indeterminate breast lumps [40 patients had single lesion and 5 patients had 2 synchronous lesions]. The sensitivity and specificity of the individual tests were as follows: 87.5% and 53.84%, respectively for physical examination, 95.83% and 84.61% for FNAC, 83.3% and 92.3% for mammography, 91.66% and 88.46% for ultrsonography. The quadruple test was 100% sensitive and 100% specific when all the tests were positive or negative, and 100% sensitive and 46.15% specific when at least one test is positive. To conclude, the quadruple test is reliable and very helpful to the surgeon and the patient in determining nature of palpable breast mass

Repair of parastomal hernia associated with incisional hernia and pendulous abdomen

Parastomal hernia [PSH] represents one of the difficult challenges for the surgeon. The association of incisional hernia [laparocele] and parastomal hernia adds to the novel of the issue especially if the abdomen is pendulous. The aim of this study is to evaluate a surgical treatment plan for such complex situations. Seventeen patients with parastomal hernia around a permanent stoma associated with laparocele and pendulous abdomen were selected for the study. They were 11 males and 6 female with a mean age of 53 +/- 9 years. After preoperative assessment, they were subjected to relocation of the stoma plus reinforcement of the laparocele repair and the old stoma site with onlay proparietal polypropylene mesh together with dermolipectomy. The overall complications were encountered in three patients Wound infection was reported in the 3 cases [17.7%], seroma in 2 [11.8%], minimal flap necrosis in 2 [11.8%] sinus formation in one patient [5.9%] and development of PSH at the new site in two patients 11.8%. The association of parastomal hernia, incisional hernia and pendulous abdomen jeopardizes the patient's quality of life and surgery is often indicated. The repair by relocation and reinforcement with onlay polyproplene mesh together with dermolipectomy represents a good solution in terms of low morbidity and an acceptable final outcome

Plication of Haemorrhoids [haemorrhoidorrhaphy] versus milligan-morgan haemorrhoidectomy

Excision of advanced haemorrhoids involving most of the anal circumference is associated with excessive bleeding, extensive raw area and anal stenosis. On the other h and, incomplete eradication means recurrence. Plication of haemorrhoids or haemorrhoidorrhaphy obliterates any degree of haemorrhoids without leaving raw areas. This r and omized study compared plication with Milligan-Morgan haemorrhoidectomy. A total of 120 patients having advanced 3rd or 4th degree haemorrhoidal disease were r and omized to undergo haemorrhoidorrhaphy [73 cases forming Group A] or conventional haemorrhoidectomy [47 cases forming Group B]. The two methods showed no significant difference as regards the operative time, cost of surgery and postoperative care, amount of pain on days 1 and 7 and on first evacuation, length of postoperative hospital stay and patients' overall satisfaction score after 6 months. However, haemorrhoidorrhaphy was associated with a significantly smaller amount of bleeding. Conventional haemorrhoidectomy was associated with temporary incontinence to flatus in 5 cases, a persistent painful raw area beyond 6 weeks postoperatively in 4 cases, anal stenosis in 2 cases and recurrence in 2 cases, while none of the cases of haemorrhoidorrhaphy had such complications. Postoperatrive retention of urine that needed catheterization was noted in 6 cases of Group A and 7 cases of Group B.A peri-anal abscess was also reported in 2 cases of group A and 3 cases of group B within the first postoperative month and were completely cured by urgent drainage. Plication of haemorrhoids gives better results in comparison to conventional haemorrhoidectomy in advanced cases although it is applicable to all grades of the disease. Such advanced cases will have the advantage of minimization of bleeding, complete avoidance of leaving raw areas which precipitate anal stenosis and complete eradication of the disease that prevents recurrence, together with preservation of the normal anal cushions

Dynamic versus static stitch, as a simple treatment for buried penis

The aim of this study was to correct cases with buried penis using a simple one-step procedure and to compare two techniques for treating these patients, using either Bucks fascia stitch [dynamic] or periosteal stitch [static]. Forty patients of buried penis were included in the study. The patients were divided into two groups: Group A, 27 patients, in whom the dynamic stitch was used and group B, in whom the static stitch was used. All results were statistically significant of the dynamic stitch technique, denoting its superiority, using delayed absorbable suture material. The procedure was better in the uncircumcised cases