Non-operative management of stable patients with abdominal stab wounds: is it feasible in Egyptian patients?

Non-therapeutic laparotomy morbidity rate in patients with stab wounds is approximately 40% . Selective conservative management, rather than mandatory laparotomy, is a better approach. We studied patients with penetrating abdominal stab wounds admitted to Alexandria Main University Hospital [Referral hospital] during 5 years from January 2001 to December 2005. This study included total 308 stabs in 275 patients, mean age 33 years [range 12-75 years]; 246 [89%] male. Mean admission systolic blood pressure of negative laparotomy in was 115 mm Hg [range 60-155 mm Hg]; while for positive laparotomy it was 90 mm Hg [range 45-140 mm Hg]. 236 [85%] only had US, and 182[65%] had CT. 112 [47%] of them bad positive clinical and/or imaging results, all underwent laparotomy: 99 [88%] therapeutic, 13 [12%] negative. In patients with negative clinical as well as US and CT, only 63[35%] had successful non-operative management and 107 [65%] had laparotomy, which was unnecessary negative in 98 [95%]. CT accurately predicted laparotomy need in 1 65/1 82 [91%] patients. In patients with penetrating stab abdominal wound, hypotension was the main clinical indicator for urgent operation. In hemodynamically stable patients, abdomino-pelvic CT with contrast bad high sensitivity to predict need for laparotomy

Combined fascial and prosthetic mesh repair for abdominal incisional hernias

Objective: Incisional hernias complicate up to 11% of incisions with a possible recurrent rate of 44%. W of the applicability and validity of combined fascial and prosthetic mesh repair in the management of incisional hernia

Methods: Forty patients [17M: 23F] were included in the study. Patients were subjected to hernia repair by a technique using both combining fascia and polypropylene mesh in the repair of all ventral incisianal hernias, regardless the site afpmm incision. Patients were followed up for morbidity or recurrence

Results: Post-operative complications included seroma formation in 6 patients, superficial wound infection in three and deep venous thrombosis in one. Post-operative hospital stay ranged from 1 to 22 days with a meal of 7.2 days. Patients were followed-up for a median of 21.3 months [range 9 to 49 months]. Two patients [5%] reported a pasistzut null local induration and one [2.5%] reported persistent local pain. Single recurrence [2.5%] was encountered in this study

Conclusion: This technique is a tension free repair applicable to all types of incisional hernias, most of due leak is lying deep under the rectus sheath and it has an acceptable complication rate with low recurrence rate