Incisional Hernia in Women: Predisposing Factors and Management Where Mesh is not Readily Available

Background:Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria during a period when prosthetic mesh was not readily available. Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18-60 months. Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1); emergency exploratory laparotomy 6/44 (13.6); and elective surgeries 12/44 (27.3). Major associated risk factors were the use of wrong suture materials for fascia repair; midline incisions; wound sepsis; and overweight. Conclusion: For elective surgeries; reduction of weight should be encouraged when appropriate; and transverse incisions are preferred. Absorbable sutures; especially chromic catgut; should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases

Correlation between endoscopic suspicion of gastric cancer and histology in Nigerian patients with dyspepsia.

Gastric mucosal biopsies of 77 dyspeptic patients whose endoscopic features were suggestive of cancer and 56 patients with uncomplicated duodenal ulcer (DU) were subjected to histopathological analysis. Gastric cancer was confirmed in 18 (23.4%) of the 77 patients but not in 59 (76.6%). 4 (5.2%) of the 18 patients had early gastric cancer (EGC). Histopathological findings in the stomach biopsy of the 59 patients in whom cancer could not be confirmed were compared with those of the 56 patients with DU. Intestinal metaplasia (IM) was present in 32.2% of the 59 cases with endoscopic suspicion of gastric cancer and in 16.1% of the 56 DU controls (P < 0.05). Mucosa-associated lymphoid tissue (MALT) occurred in 28.8% of the cancer-resembling cases and in 12.5% of the DU patients (P < 0.05). The difference in the prevalence of gastric mucosal atrophy and Helicobacter pylori infection between the two groups (83% vs. 71.4%) did not reach statistical significance (P > 0.10). All 18 patients with gastric cancer were positive for Helicobacter pylori and the prevalence of the infection approached 95% in those with IM and MALT. This study shows that IM and MALT present with endoscopic appearances that resemble that of gastric cancer and that along with the latter, their main aetiological agent is Helicobacter pylori.