Laparoscopic repair of ventral hernia: an initial experience

With the evolution of minimally invasive surgery, it is thought that a potential is present to reduce the postoperative complications of ventral hernia repair. Theoretical advantages of laparoscopic repair include faster recovery less postoperative pain, less morbidity, and a better cosmetic result. The purpose of this study is to report the results of our initial experience with laparoscopic tensionfree repair technique using polypropylene mesh in patients with primary ventral hernia. From March 1996 to December 1998, laparoscopic ventral hernia repair was performed on 22 patients. There were 14 women and eight men. Age of patients ranged between 28 and 55 years [mean 46.4 years]. Type of hernia included ten para-umbilical and 12 incisional hernias. Body mass index of patients was ranging between 24 and 49 kg/m[2] [mean 31 +/- 9.7 Kg/m[2]] The size of the hernia defect ranged between 20 and 160 cm[2] [mean 96 cm[2]]. Polypropylene mesh was used in all cases and the mesh size was varying from 6x6 to 20x20 cm [median 12x12 cm].There were no deaths. In two patients [9%] conversion to open surgery was mandatory. Six complications [30%] were recorded among the twenty patients who completed the laparoscopic procedure. Most of them were minors and only one patient [5%] developed intraabdominal abscess and needed surgical intervention. No complications related to intestinal adhesion or fistula formation were recorded. The mean operating time was 90 minutes. It was 105 minutes in the initial 10 patients and decreased in the subsequent 10 cases to a mean of 85 minutes. The mean hospital stay was 2.5 days [range: 1-12 days]. After a mean of 15 months follow up [range 12 to 23 months], no recurrence was recorded.Laparoscopic ventral hernia repair offers advantages over the conventional open mesh repair and may decrease the hernia recurrence rate. When properly performed, the laparoscopic approach does not compromise the principles for successful mesh repair of ventral hernias.Also decreased hospital stays postoperative pain, and wound complications, are benefits of this technique.Regarding the type of mesh, good results can be obtained using polypropylene mesh

Primary pull-through for Hirschsprung's disease: abdominal vs transanal

In the last few years, one stage pull-through operation for Hirschsprung's disease has replaced the previous gold standard of 2 or 3-stage procedures. One stage procedure can be done abdominally, by laparoscope, or completely trans-anally. In this research, we compared trans-anal with abdominal approach for one-stage pull-through for Hirschsprung's disease. The study was done in Zagazig University Hospitals and included 24 patients with biopsy proven Hirschsprung's disease. The patients were selected according to standard inclusion and exclusion criteria, and were prospectively randomized into group A with trans-anal and group B with abdominal approach. Assessment included patients data, operative and early post-operative courses. Also, late operative sequelae [within 6 months] were evaluated according to unified system. There was significant increase in operative blood loss and hospital stay in-group B. No significant difference was evident between the two approaches concerning early and late postoperative sequelae. Avoidance of laparotomy in trans-anal route is attractive, but more studies are needed to confirm its safety and to stratify indications and contraindications of its use

Effect of isovoleamic haemodilution with hydroxyethyl starch and albumin on thrombus formation in artificial aortic grafts

Fluid resuscitation aims to maintain intravenous volume without significant effects on hemostasis. Several types of intravenous fluid are available for use in a patient who has suffered trauma, but there is evidence that some resuscitation fluids may affect primary hemostasis. The present study was designed to investigate the effects of isovolaemic haemodilution with hydroxyethyl starch [HES] and albumin 5% on thrombus formation in artificial arterial grafts. Twenty rabbits were included, the animals were subdivided into three groups as follows: group 1 [6 rabbits] received isovolaemic haemodilution with HES [10 ml /kg], group 2 [7 rabbits] received haemodilution with albumin 5% [10 ml / kg] and group 3 [7 rabbits] non-haemodiluted controls. A polytetrafluoroethylene graft [PTFE length 13mm, inner diameter 3mm] was inserted into the abdominal aorta of the rabbits. After 2 days the vessel grafts were removed and weighed. The thrombus masses were scraped from the inner surfaces and weighed separately. The studied parameters were the aortic blood flow and the amount of thrombus formation. The results showed that the blood flow increased by about 70% and 60% after haemodilution with HES and albumin, respectively, and remained high in the haemodiluted animals after insertion of the graft. Also, the amount of thrombus formation in the inner wall of the graft was reduced by haemodilution with HES. In conclusion, isovolaemic haemodilution with both HES and albumin increased blood flow in the rabbit, while haemodilution with HES also reduced the amount of thrombus formation

Treatment of postoperative external duodenal fistula using roux-en-y jejunal loop

postoperative external duodenal fistulae are associated with significant mortality and morbidity. Although medical management is followed by closure of fistulae in up to 90% of patients, mortality and mortality rates are sill high among those who would not respond to this treatment. In addition, there is no technical recommendation as regards the surgical intervention as each operative procedure has its own limitations, mortality and morbidity. to evaluate the outcome of using Roux-en-Y jejunal loop for closure and drainage of postoperative external high-output duodenal fistulae. a series of prospective cases from March 1993 to February 1998. Department of Surgery, Faculty of Medicine, Zagazig University. seventeen patients with postoperative external duodenal fistulae, in whom surgical intervention was indicated, were treated using Roux-en-Y jejunal loop anastomosed to the fistula stoma. four patients [23.5%] died in the early postoperative period [30 days]. Morbidity was related to chest infections, intraabdominal infections, multiorgan failure and burst abdomen with a total major complications rate of 58.8%. the Roux-en-Y operation is recommended for difficult fistulae that do not heal with medical management. It is a safe one-stage procedure that is suitable for high-risk patients

Protection of colonic anastomosis by an intraluminal bypass tube: an experimental study

The intracolonic bypass procedure is one that prevents gastrointestinal secretions and faecal content from coming into contact with the anastomotic site without interrupting the intraluminal continuity. This is achieved by the intraluminal implantation of soft, pliable tube above the anastomotic site. In this experiment, 60 Egyptian dogs were operated upon under maximal stress circumstances for colonic leakage. The results of the study showed that this intracolonic bypass tube is an alternative to a temporary colostomy. The study showed that the intracolonic bypass tube would not prevent an anastomotic dehiscence but can prevent anastomotic leakage with its associated complications in situations where dehiscence is more likely to occur

Criteria for choice of an outpatient procedure for treatment of bleeding hemorrhoids

Although numerous non-operative treatments for management of hemorrhoids have been suggested, none has been reported to be superior to the others in control of bleeding due to hemorrhoids. In this study, three non-operative procedures were used in treatment of bleeding hemorrhoids in 118 patients. Sixty three patients were treated by infrared coagulation in a total of 110 sessions, 31 patients were treated by rubber band ligation in 53 sessions and 24 patients by injection sclerotherapy in 31 seasions. The efficacy of each procedure in controlling bleeding was correlated to the degree of hemorrhoids and severity of pre-treatment bleeding taking into consideration pain experienced during application of the technique, complications, recurrence rate and cost-effectiveness. Infrared coagulation has a total cure rate of 89.5% which was higher in patients with first- and second-degree hemorrhoids and lower in patients with severe bleeding regardless the degree of hemorrhoids. On the other hand, rubber band-ligation was superior to infrared coagulation in control of severe bleeding and in patients with third degree piles. Injection sclerotherapy had highest recurrence rate [20.8%] whatever was the degree of hemorrhoids and the severity of bleeding. These data, indicate that, except for those with interno-external hemorrhoids or associated anal fissure, all patients with bleeding hemorrhoids could be treated in the outpatient clinic and procedure should individualized according to the degree of hemorrhoids and severity of bleeding