Stoppa preperitoneal approach [GPRVS] versus laparoscopic TAPP approach in management of bilateral inguinal hernia: a multicenter study

The preperitoneal approach for inguinal hernia avoids distorting the inguinal anatomy, markedly reducing the risk of damage to the testicular vessels and permits inspection of all potential groin hernia sites. In this, study we are trying to validate and compare two preperitoneal approaches used for repairing bilateral inguinal hernias; the Stoppa [GPRVS, giant prosthetic reinforcement of the visceral sac] and the laparoscopic transabdominal approach [TAPP]. Two hundred forty two [242] patients with bilateral inguinal hernia were treated at 3 University hospitals. They were randomly divided into two groups the first group [gp I] was 97 patients and underwent laparoscopic TAPP repair while the second group [gp II] was 143 patients and submitted for Stoppa preperitoneal repair [5 patients were turned from TAPP to Stoppa repair due to instrument failure in 2 patients, adherent intestinal loops with difficult reduction of the contents in 2 patients and bleeding from inferior epigastric vessel in l patient]. Operative time was 110 +/- 65 min in TAPP group and 90 +/- 20 min in Stoppa group. Hospital stay and need for analgesics were less with TAPP group than Stoppa group. Recurrence rate was- 5.1% in TAPP group and 2.1% in Stoppa group. Complications were slightly higher with Stoppa group except for chronic groin pain which was higher with TAPP. Both Stoppa and TAPP are valid preperitoneal repairs for bilateral inguinal hernias. Both are techniqually demanding operations. Stoppa has fewer recurrences but has slightly higher complication rate except for chronic groin pain which is more reported after TAPP. TAPP has the advantages of posing smoother postoperative course with shorter hospital stay

Synthesis of thieno, pyrazolo and isothiazolo-pyrimidine derivatives based on o-mercaptoacetylpyrimidine derivative

Mercaptopyrimidine 4 was prepared and transformed into methylmercaptopyrimidine 5. Compound 5 was transformed into pyrazolopyrimidine 6, and cinnamoylpyrimidine 7. Compound 4 reacted with halomethylene to produce thienopyrimidines 9, 10. Pyrimidine 4 was converted into pyrimidine derivative 12a,b, upon treatment with H2O2 in acetic acid and NaOH, respectively. Oxidation of 4 leads to disulfide 13. Heterocyclization of 4 using NaOCL in the presence of NaOH/NH [4]OH afforded isothiazolopyrimidine 15. Heterocyclization of 4 using aromatic aldehydes gives thiopyranopyrimidines 17a,b. Chlorination of 4 afforded chloropyrimidine 18, which was transformed into pyrrolopyrimidine 20 and pyrimidine derivatives 21a,b,c,d