Laparoscopic repair of ventral hernia

To determine the outcome of patients in terms of wound complications and follow-up, after laparoscopic ventral hernia repair. A case series study. Department of Surgery, Dubai Hospital, Dubai, from January 2007 to December 2011. All patients above 13 years of age, who underwent laparoscopic ventral hernia repair, were included. A proceed dual mesh was used for repair of hernia. Multiple parameters were analyzed, including demographic features, presentations, co-morbid conditions, duration of hernia, and defect size. The duration of surgery, postoperative complications, and follow-up of these patients in terms of suture site pain and recurrence of hernia were also analyzed. The data was expressed as frequency, percentages and mean +/- standard deviation of values. There were 27 patients with mean age of 47 +/- 10.3 years, including 20 female [74.07%] and 7 male [25.95%] patients. All patients presented with abdominal wall swelling. The hernia was partially reducible in 12 patients [44.44%], and completely reducible in 15 patients [55.55%]. Seven patients [25.95%] had hypertension, 4 [14.81%] had ischaemic heart disease, and 4 [14.81%] had obesity as co-morbid conditions. All patients underwent laparoscopic hernia repair with proceed dual mesh. The mean defect size of the hernia was 6 cm, and mean duration of surgery was 94 minutes. Early postoperative complications included, seroma in 3 patients [11.11%], and haematoma in one patient [3.70%]. The mean follow-up was 23 months. Four patients [14.81] had pain at suture site. Laparoscopic repair is an appropriate approach for ventral hernia repair. It results in good repair and low wound complications in terms of haematoma and wound infection. There was no recurrence of hernia in this study

Venous thromboembolism risk and prophylaxis in a Saudi hospital

To evaluate the risk factors and physician's compliance to American College of Chest Physicians [ACCP] guidelines recommendations for venous thromboembolism [VTE] prevention at our hospital. This retrospective cohort study was conducted at King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia from November 2009 to December 2009. We used the American College of Chest Physicians [ACCP] 2008 guidelines and Caprini's scores to assess VTE risk and to determine whether patients had received recommended prophylaxis. All hospital in-patients aged 15 years or above were assessed for risk of VTE by reviewing the hospital chart. A data sheet was developed to obtain the data on demographics, VTE prophylaxis medication, dose, route, duration, and associated risk factors. The primary endpoint was the rate of appropriate thromboprophylaxis. Nine hundred and sixty-eight patients were included. The mean age was 40 +/- 18.7 years, and 647 [66.8%] were women. According to the ACCP criteria, 547 [56.5%] patients were at risk for VTE. Of 210 patients that qualified for prophylaxis, 117 [55.7%] received some form of prophylaxis. However, 46 [39.3%] of them received ACCP-recommended VTE prophylaxis. In contrast, 25.6% of patients with no risk, according to Caprini score, had thromboprophylaxis prescribed. This study demonstrates that only a small proportion of eligible patients received the recommended VTE prophylaxis. Efforts should be made to develop strategies to improve patient safety practices

Acute mesenteric ischemia: experience in a tertiary care hospital

Acute mesenteric ischemia is an abdominal catastrophe. This has been described as a complex of diseases rather than a single clinical entity. The incidence in United States is 1 in 1000 hospital admissions. The objective of this descriptive study was to determine the clinical presentations and out come after surgery of patients with acute mesenteric ischemia. It was conducted at Dubai Hospital, Dubai, United Arab Emirates. All patients having per operative or histopathological diagnosis of acute mesenteric ischemia from 2002 to 2006 were included. There were 16 patients in all. Their mean age was 51 years, 12 were male and 4 were female. Abdominal pain was present in 16 patients, vomiting in 12 and anorexia in 9 patients. Abdominal tenderness was present in 16 patients, abdominal distension and rebound tenderness in 12 patients. Five patients had hypertension, 4 had myocardial infarction and 4 had diabetes mellitus as risk factors. X-Ray abdomen was done in 13 patients, Ultrasound in 9 and CT Scan in one patient. Resection of bowel was done in 14 patients. Post operatively 5 patients developed pneumonia, 3 had wound dehiscence, 3 had sepsis, and 3 had Lower GI bleeding. Five patients were expired after surgery in the hospital. Four patients were lost to follow up. We should have a high index of suspicion for mesenteric ischemia in patients with unexplained abdominal pain. Early diagnosis and prompt surgical intervention improves the outcome

Magnetic attraction: dual complications in a single case

A case report of a 19-years-old mentally retarded girl, presented with abdominal pain, nausea and vomiting of two days duration. Physical examination revealed abdominal tenderness with guarding and rigidity. Exploratory laparotomy revealed the presence of magnets in the jejunum with perforation of jejunum and a resultant gastro jejunal fistula. The procedure involved enterotomy for removal of magnets, resection of the segment of the bowel with fistula and perforation and end-to-end anastomosis. The association of ingested magnets, leading to dual complications, is a rare case ever reported in Dubai

Choledochal cyst associated with heterotopic pancreatic tissue

This is a case report of a 44 year old male, who presented with upper abdominal pain, vomiting, and fever for two days. On examination, he was jaundiced and febrile. His abdomen was tender in epigastrium and right hypochondrium. CT scan and MRCP revealed a cyst in the region of head of pancreas, extending toward liver. ERCP was not successful. He was operated, and cholecystectomy, excision of the cyst and biliary enteric anastomosis were done. The presence ofcholedochal cyst associated with heterotopic pancreatic tissue in the cyst is a rare association