Non-ligation of the hernial sac during repair of indirect inguinal hernia

The present study was designed to study the effect of. non-ligation of the hernial sac of indirect inguinal hernia during repair. As ligation of the hernial sac has been considered mandatory for a successful repair and essential for preventing recurrence, the recent studies found that non-ligation of the hernial sac has no effect on recurrence rate and may decrease post operative pain, so we can recommend that it is not necessary to ligate the hernial sac during inguinal hernia repair, as ligation of the hernial sac is a hallowed and time consuming concept and result in increase post operative pain, however, this concept has been contested in recent studies. We conducted a prospective study on sixty patients of indirect inguinal hernia repair. In thirty cases the sac was ligated at the neck and excised [control group] in the other thirty cases the sac was not ligated at all, and either inverted or excised without ligation [test group]. The chosen type of repair was Lichtenstein's repair. Post-operative pain was significantly less in those cases where hernial sac was not ligated as it is recorded by pain score. Also there were no recurrence in either groups at one year follow up. Ligation of the hernial sac during inguinal hernia surgery is not only unnecessary and time consuming but also may increase post-operative pain. And has no effect on recurrence rate

Rhomboid flap versus fasciocutaneous V-Y advancement flap in treatment of pilonidal sinus

Pilonidal sinus of the natal cleft is one of the common surgical problems and represents a challenge to many surgeons, because the high incidence of recurrence and long postoperative morbidity course. Although many methods of surgical and non surgical approaches have been proposed to overcome these problems, an optimal treatment modality has not been achieved yet. Evaluation of two different types of surgical procedures for surgical treatment of Sacrococcygeal pilonidal sinus; Rhomboid flap technique and V-Y advancement flap technique, comparing the results of each one separately. 30 patients with chronic pilonidal sinus disease were admitted to surgical department in Ain Shams University hospital during the period from December 2002 to August 2003. The patients were divided into two groups. Group [A]. 15 patients, 13 of them were classic cases while 2 cases were recurrent cases. This group was treated by excision of the sinus and closure the wound by Rhomboid flap technique. Group [B] 15 patients, 12 of them were classic cases while 3 cases were recurrent cases. This group was treated by excision of the sinus, and closure the wound by V-Y advancement flap technique. In group [A], mean hospital stay was 5 days, mean healing time was 15 days, and only 2 cases developed wound infection, while in group [B], mean hospital stay was 7 days, mean healing time was 17 days, and only one case of wound infection. No recurrence detected in both groups during the whole period of follow up [12 months]. Treatment of chronic pilonidal sinus of the natal cleft can be efficient using one of the both techniques mentioned above, as both techniques having the same principles [flattening of the natal cleft and keeping the scar away from the midline]. We advise the use of one of both techniques for the treatment of chronic pilonidal sinus disease, specially the V-Y flap advancement for treatment of recurrent complex cases allowing removal of all pathological tissues, and rhomboid flap for simple classic cases