ABSTRACT
Background: Hernia repairs, both inguinal and ventral/ incisional, are some of the most common surgeries performed in the world. Over the last 5 years, the field of hernia surgery has had a significant transformation thanks to many new and innovative surgical techniques as well as exponential growth in mesh and mesh technology. The aim of the study: To compare the intraoperative complications of TEP vs TAPP vs open hernioplasty in terms of operative time, major visceral or vessel injury and conversion rates. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, and Chennai in 2018. 75 patients (25 cases of open hernioplasty, 25 cases of TAPP, 25 cases of TEP). Post-operative pain was recorded based on Visual Analog Scale and requirement of analgesics. Post-operative complications like urinary retention, wound seroma, wound hematoma, wound infection, port site infection, recurrence, mesh infection, bowel complication was collected with clinical examination and complications recorded. Results: The study involved 75 male patients who satisfied the inclusion criteria. 25 patients were subjected to Lichtenstein tension-free open hernioplasty, 25 treated with TEP, and another 25 subjected to TAPP. Among the 75 cases studied 21 cases were found to have left sided inguinal hernia, whereas 54 cases were having right sided hernia. Intraoperative complications like major vessel injury or bladder injury were observed. No intraoperative complications were encountered Rosy Adhaline Selvi, Manimegalai. Comparative study of complications following laparoscopic TEP versus TAPP versus open hernioplasty in inguinal hernia repair. IAIM, 2019; 6(3): 223-230. Page 224 during the study period in any of the groups. Post-operative urinary retention was found only in two cases of Lichtenstein tension-free open hernioplasty and this required bladder catheterization. All cases of laparoscopic hernioplasty were catheterized intraoperatively and catheter retained till postoperative day 1, hence urinary retention could not be assessed. The post-operative pain was measured using the Visual Analog Scale (VAS) 6 hours after the surgery. The patient was given a dose of Injection Tramadol 100mg in after the surgery. The pain scores were analyzed with Chi-square and the difference found to be statistically significant. Lichtenstein tension-free open hernioplasty was found to have increased postoperative pain when compared to laparoscopic repair. Among the laparoscopic repair, TAPP was found to have increased postoperative compared to TEP. The postoperative hematoma was observed in a single case of Lichtenstein open hernioplasty. The hematoma was in the subcutaneous plain and required drainage. Conclusion: Primary unilateral inguinal hernia without complications can be treated with Lichtenstein tension-free open hernioplasty or laparoscopic transabdominal preperitoneal hernioplasty or laparoscopic totally extraperitoneal hernioplasty. Lichtenstein open hernioplasty has an advantage over laparoscopic repair in terms of shorter duration of surgery and learning curve.
ABSTRACT
Background: Carcinoma of the breast is the most common of non-skin malignancies in women and is second to lung cancer is a cause of cancer deaths. A woman who lives to age 90 has a one in eight chance of developing breast cancer. It is as ironic and tragic that a neoplasm arising in an exposed organ, readily accessible to self-examination and clinical surveillance, continues to exact such a heavy toll. The aim of the study: To determine, if differences in the extent of axillary node dissection would alter the number of reported positive nodes, to emphasize the presence and importance of dissecting the inter pectoral node (Rotter’s Node) in Modified Radical Mastectomy. Materials and methods: This study was conducted in the Department of General Surgery, Government Stanley Medical College, Chennai in 2018. Patients were evaluated according to NCCN guidelines and were subjected to Modified Radical Mastectomy for whomsoever it was needed. 32 cases underwent Modified Radical Mastectomy with complete axillary dissection (level I/II/III and inter pectoral node) according to the identical procedure. The dissection was carried out in all patients, irrespective of whether they had palpable nodes or not clinically. Results: An average of 13 lymph nodes was examined per case (range: 8−20). Axillary lymph node involvement was found in 56% of the cases (18/32). Of the 18 cases, 83% (n = 15) had involvement of level I/II nodes only, and 16% (n = 3) had positive ALN in levels III and, or, inter pectoral nodes, in addition to the level I/II. Involvement of lymph nodes in level III and inter pectoral nodes without a level I metastasis was not found. By the inclusion of level III to a level I/II dissection, two cases (11%) was converted from one to three positive nodes (pN1) to ≥4 positive nodes (pN2). Involvement Rosy Adhaline Selvi, Manimegalai. Scrutiny of extent of axillary node dissection for patients with primary breast cancer. IAIM, 2019; 6(3): 212-216. Page 213 of lymph nodes in level III was found in 3 cases (16%) 10/32 cases (31%) had ≥4 positive nodes who required adjuvant therapy. Conclusion: Variations in the level of axillary node dissection for breast cancer which includes the inter pectoral and level III nodes can result in significant changes in the number of positive axillary nodes stepping up the pathologic nodal status from pN1 to pN2. This can potentially bias adjuvant therapy recommendations if treatment decisions are based on this prognostic factor.