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

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