Role of surgery for chronic groin pain by inguinal neurectomy

Inguinal nerve entrapment is a debilitating post operative problem. Fifty patients were treated for inguinal nerve entrapment including 26 men and 24 women with an average age of 45 +/- 14 years Most patients had inguinal hernia repairs or Pfannenstiel incisions. Mesh was found in 27% of patients. Symptoms included pain [100%] radiation of pain to the thigh and/or genital area [59%], and postural pain [59%]. Diagnosis was made by physical examination, postural maneuvering, and inguinal nerve block. Proximal nerve resection was followed by polyester ligature and absolute alcohol application to prevent neuromas. Eight percent of patients had minor complications. Total pain relief was attained in 72% of patients, partial relief in 25%, and no relief in 3%. Two patients complained of numbness postoperatively. Multifactorial analysis showed recurrent hernia repair as a significant predictive factor

Mini laparoscopic cholecystectomy: a better outcome

The outcomes after traditional laparoscopic cholecystectomy [LC; one 10 mm port, one 12 mm port and two 5 mm ports] and mini laparoscopic cholecystectomy [MLC; three 3mm ports and one 12mm port] for gall stone disease were compared. The study was a randomized, single blind trial comparing LC with MLC. The randomization period was from February 2003 to December 2004. Two groups of patients underwent the surgery, 48 underwent LC and 47 underwent MLC. Patients were randomized by means of a blind envelop system just before surgery. The groups were matched for age, sex and preoperative characteristics. Median [range] operating times for LC and MLC were similar 45 [20- 120] and 50[20-170] mm. respectively. Intraoperative and postoperative complication rates, the time for the patient to resume walking, eating and passing stools, and median hospital stay were the same in the two groups. The level of post operative pain was lower in the MLC group at 1 h, 3h, 6h, 12h and 24h. Patients who had MLC received fewer injections of analgesic [p=0.036] and more patients in this group expressed satisfaction with the cosmetic result [p= 0.001]. MLC took a similar time to perform and caused less postoperative pain than the standard laparoscopic procedure. Reducing the port size further enhanced the advantages of laparoscopic over open cholecystectomy

cutting seton technique for management of high perianal fistula

Seton technique have been used for treatment of high perianal fistula for thousands of years with successful results. This prospective study reports the results of the cutting seton technique in addition to distal fistulotomy for treatment of high perianal fistula. Twenty two patients, 17 [77.3%] males and 5 [22.7%] females, aged between 20 and 57 years [median 35.5 years] presented with high perianal fistula included in this study. While the patients in the lithotomy position, injection of methylene blue followed by probing was done, care was taken not to do false passage. Subcutaneous track was bayed open till anal sphincter complex, the anoderm and the mucosa overlying the fistula was incised, 2 Nylon No 1 sutures were passed through the fistula and tied over the sphincter complex. The ties were tightened every two weeks in outpatient clinic postoperatively. Thirteen [65%] patients had a normal postoperative continence but 7 patients [35%] had postoperative incontinence [4 patients [20%] incontinent for gases, 2 patients [10%] incontinent for liquid stool and one patient [5%] incontinent for solid stool]. Six patients had been completely recovered and one had permanent incontinence. All fistulae were healed from 10 to 20 weeks [median 14 weeks]. There were two fistulae recurrence during the study period, one was treated successfully by the same procedure