Lichtenstien repair of inguinal hernia under local anaesthesia - day case surgery

This prospective study was carried on 250 patients to study the complication and recurrence rate associated with Lichtenstien repair of inguinal hernia in our clinical and socioeconomic settings. The cost effectiveness and return to work after surgery were the other outcome measures. Two hundred and fifty patients underwent mesh repair of inguinal hernia at two different centers over a period of two years. All the patients were operated under local anesthesia. A bolus dose of preoperative antibiotic was given intravenously. The patients were followed up for two years and their post operative course was assessed according to a prescribed proforma. The rate of minor complications was in the range of 11.8%. The recurrence rate was 1.2%.There was minimal pain and the procedure was cost effective in terms of operative cost and less economic loss due to early return to work. It is concluded that Lichtenstien repair as a day case is safe and effective procedure to be performed by a trained general surgeon under local anesthesia. The infection rate and the recurrence rate are low. The compliance and acceptability of the patient and ease of carrying out the procedure under local anesthesia by surgeon is acceptable. In our view this type of hernial repair is an appropriate method in district hospital and tehsial headquarter hospitals where provision of anaesthesia facilities are yet to be fully developed and hospitals cater a major hernial load due to elderly patients with background of farming professions being admitted. The patient can be sent home on same day after surgery

Extramucosal single layer interrupted intestinal anastomosis: a better alternative

To evaluate the technique of extra mucosal interrupted single layer intestinal anastomosis in different diseases where anastomosis is needed in different parts of gastrointestinal tract both in elective and emergency situations. Design: Prospective study. Place and Duration of Study: Surgical Unit 1 Jinnah Hospital Lahore, over a period of 2'/2 years from December 2000 to June 2003. Material and In this study 123 anastomosis were performed in 100 patients. All these patients were operated upon by the senior surgeons in the emergency/elective operating rooms. Single layer interrupted extramucosal anastomosis with vicryl 2/0 or 3/0 was done in all cases. Overall anastomotic leak was just 0.81%. Wound infection was observed in 6%, without any increase in morbidity and zero% mortality. Extramucosal single layer interrupted intestinal anastomosis is the safest technique both for the small and large bowel, with minimal possible complications