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

laparoscopic management of the impalpable testicle: could it be the standard procedure?

From August 1998 to Jane 2001, we managed 19 patients aged 3 4-28 [mean 21] years with unilateral impalpable testicles [8 right and 11 left]. Inguinal ultrasonography [US] was done to- all patients pre-operatively and one inguinal testicle was detected. Examination under anaesttesia detected another inguinal testicle. Open trans-inguinal ororchidopexy was done for both. The remaining 17 patients were all subjected tolaparoscopy with diagnostic and therapeutic intentions 7 intra-abdominal non-atrophic testicles with long tortuous testicular vessels were managed by laparoscopic one-stage orchidopexy with preservation of testicular vessels. Two intra-abdominal non-atrophic testicles with short direct testicular vessels were managed by laparoscopic two-stage Fowler-Stephens [F-S] procedure at six-month interval. One intra-abdominal atrophic testicle was managed by laparoscopic orchidectomy. One intra-abdominal blind-ending vas deferens needed no further management In 6 patients the vas and vessels were seen entering the internal inguinal ring and inguinal exploration was done at the same setting with the following results; 2 non-atrophic testicles were managed by orchidopexy, 3 atrophic testicles were managed by orchidectomy and one blind-ending vas needed no further management. Among our 19 patients, there were 7 epsilateral hernial sacs, Which were managed by inguinal hernia repair at the same operative setting without recurrences at 6-month follow-up, Laparoscopic localization of testicular position was 100% successful. The success rate of laparoscopic orchidopexy [7 one-stage and 2 two-stage F-S] was 89%, which was defined as scrotal testicular position without atrophy at 6 months follow-up. Apart from one minor self-limited subcutaneous emphysema, laparoscopic procedures were not attended by complications. Our study confirms the safety and efficacy of laparoscopic diagnosis and therapy of impalpable testicles in adults