ABSTRACT
About 95% of the patients suffering from duodenal ulcer and 70-80% of the gastric ulcer patients are found to be Helicobacter pylori (H. pylori) positive. Although the role of H. pylori is well known in peptic ulcer disease aetiology, its role in perforated peptic ulcer is not well established. There are conflicting results in the literature regarding its association, with some studies showing high prevalence of H. pylori infection in gastro-duodenal perforation patients and also its eradication prevented the relapse of ulcer while others showing low or lack of association, suggesting a different pathogenesis for perforated peptic ulcer.METHODSGroup-I patients were operated for gastro-duodenal perforation and group-II patients were with the upper gastrointestinal endoscopic diagnosis of peptic ulcer disease. The mucosal biopsy samples taken from antrum from both the groups were tested with rapid urease test and histopathological examination to detect H. pylori.RESULTSThe prevalence of H. pylori infection was significantly less in patients with perforated gastro-duodenal ulcer than with peptic ulcer disease (p-value-0.026; OR – 0.31).CONCLUSIONSThrough this study it was found that alcohol intake and smoking were significant risk factors associated with perforation of gastro-duodenal ulcer whereas NSAIDs use was not significantly associated. H. pylori infection was not significantly associated with perforated gastro-duodenal ulcer suggesting that some other factors were involved in perforation.
ABSTRACT
Incisional hernia is one of the common complications encountered following abdominal surgery and is an important cause of morbidity. It can be repaired by following anatomical, mesh or laparoscopic methods. The incidence of these hernias is high even with recent advances in surgery, anaesthesiology, antibiotics, and suture materials used. We wanted to study the epidemiology, aetiology, mode of presentations, modalities of treatment and its outcome, of incisional hernia.METHODSThis study was done from July 2017 and June 2019, 50 patients with incisional hernia who got admitted in the Department of Surgery at Sri Venkateshwaraa Medical College and Research Center, Ariyur were subjected to anatomical or mesh repair depending on the surgeon’s choice and size of defect. A total of 50 cases were studied and followed for a period of 6- to 18-months. Patients of age 12 years and above of both sexes who presented with incisional hernia post abdominal surgery were included in this study. Age below 12 years and those presented with other hernias like inguinal/ventral hernias were excluded. Data was collected and analysed by various statistical methods. RESULTSIncisional hernia was found to be the second most common type of hernia. The incidence was more common in females, who underwent gynaecological procedures by lower midline incisions. It was found to be more common in the age group 30-60 years. Predominant risk factors being wound infection and obesity. Infraumbilical midline incision (50%) was found to be more common compared to other incisions. Majority of patients who underwent emergency surgery developed incisional hernia. Postoperative complications noted were mainly due to wound infections and seroma.CONCLUSIONSMesh repair results in less recurrence than anatomical repair for incisional hernia. The incidence of incisional hernia is more common in women than men due to abdominal wall weakness secondary to multiple pregnancies, increased number of caesarean sections and gynaecological surgeries. Sterile aseptic technique and appropriate use of pre-operative antibiotics is necessary to reduce the occurrence of incisional hernia.