RESUMEN
Background: Incisional hernia is a common problem following a midline vertical incision in all patients undergoing open bariatric procedures
Patients and methods: The present study was conducted on 30 morbid obese patients who underwent vertical banded gastroplasty [VBG] operation through upper midline incision. The patients were randomly divided into three groups. Group I: Patients for whom the midline abdominal incisions were reinforced by subfascial preperitoneal polypropylene mesh before closure of the linea alba. Group II: The midline abdominal incisions were reinforced by prefascial subcutaneous polypropylene mesh after closure of the linea alba. Group III: The linea alba was closed en-mass with continues polypropylene No 1 sutures [standard closure]
Results: The mean age was 30.4 years. Twenty-four patients were females [80%] and six were males [20%]. The mean body mass index was 45.4kg/m2. The commonest associated medical conditions were, osteoarthritis detected in 18 patients [60%], hypertension in 17 patients [56.7%], type II diabetes mellitus in 15 patients [50%]. Most of the patients presented with more than one associated medical condition as, osteoarthritis 6' hypertension. The mean time of incision closure was 36 minutes in group I, 31 minutes in group II and 15.4minutes in group III. Early postoperative wound complications were, superficial wound infection in one patient of group I [10%], in 3 patients of group II[30%] and in one patient of group III[10%] . Partial wound disruption in 2 patients of group 11[20%] and in one patient of group III[10%]. Subcutaneous seroma in one patient of group I[10%], 3 patients of group II[30%] and one patient of group III [10%]. During the period of follow up [mean of 22 months], chronic pain at the scar site was reported in 2 patients of group 100%], 3 patients of group II[30%] and one patient of group III[10%]. Incisional hernia reported in 3 patients of group Ill [30%]
Conclusion: The subfascial placement of the mesh has many advantages over prefascial position, as, the possibility of bowel obstruction or fistula formation is not present, likewise, the risks of seroma and wound infection were minimized. The subfascial technique also does not initiate adhesions between the subcutaneous tissue and rectus sheath with subsequent difficult dissection during late dermolipectomy if needed. Subfascial placement of the mesh is a very simple technique and is recommended as an ideal method for closure of the midline abdominal incisions in morbid obese patients
RESUMEN
Objective: Ideal technique for effective inguinal hernia repair is still controversial
Patients and methods: The presented study was conducted on 80 male patients with uncomplicated unilateral primary inguinal hernia. The patients were randomly selected either for modified Shouldice repair [36 patients] or Liechtenstein repairs [44 patients]. Patients were followed postoperatively for 2 years
Results: The mean age of the patients was 34.4 years for Shouldice group and 32.710! Lichtenstein group. The mean operative time was 74 minutes for modified Shouldice repair and 56 minutes for Lichtenstein repair. No intra-operative complication! occurred in patients of both groups. Postoperatively, in the Shouldn't: group, 18 patients [50%] reported slight pain, 12 [33.3%] reported moderate pain and 6 [17.7%] reported severe pain, while in the Liechtenstein group, 11 patients [25%] reported no pain, 20 patients [45.6%] reported slight pain and 13 [29.4%] reported moderate pain. The patients a] Lichtenstein group required postoperative analgesia less than patients of Shouldice group. The mean hospital stay was 4 days for Shouldice group and 2 days for Lichtenstein group. The mean time of return to unrestricted physical activities was 16 days In Shouldice group and 12 days in the Lichtenstein group. Early postoperative complications were. inguinal seroma reported In one patient [2.8%] of the Shouldice group and in 3 patients [6.9%] of the Lichtenstein group and superficial wound infection In 2 patient! [5.6%] of Shouldice group and in one patient [2.3%] of Lichtenstein group. During the period of follow-up, pain at the surgical site was reported in 6 patients [16.7%] of Shouldice group and in 12 patients [27.3%] of Lichtenstein group, feeling of a foreign body in the groin was reported in 16 patients [36.4%] of Lichtenstein group. There was no statistically significant difference between pre-and postoperative spermogram and Doppler flow parameters for both groups
Conclusion: Both techniques are largely equivalent with advantage for the mesh repair because of easier performance, shorter operative time and rapid return to full physical activities