Mesh versus non-mesh repair, eleven years experience at Shaikh Zayed Hospital, Lahore

Ventral Incisional Hernias are a well known complication after abdominal surgery with a reported incidence of 10% - 20% and a recurrence rate of 30% - 50% after open suture repair and less than 10% after open mesh repair. To compare the outcome of two different methods of open repair of VIH [i.e. Mesh versus Non-mesh or Suture Repair in terms of morbidity, complications and recurrence. 11 years period [January 2000 - December 2010]. Shaikh Zayed Hospital, Lahore. The total number of patients who underwent surgery for repair of VIH during the study period was 321.There were only 33 patients in Group A [simple suture/Keel repair] while Group B had 288 patients. The most common early postoperative complications seen in both the groups were wound seroma and infection. Post-operative respiratory insufficiency was more common in the obese. Chronic pain and feeling of foreign body was more frequently seen in the mesh group. On the other hand, recurrence rates were far greater in the suture repair group. The overall mortality in the whole series was 3 patients [0.93%]. The rates of ventral incisional hernia recurrence and complications are significantly lower after open onlay mesh repair as compared to the open suture repair. However, these results require confirmation by prospective randomized clinical trials which should also include the results of laparoscopic ventral incisional hernia repair which is a new and emerging technique in Pakistan

Critical factors effecting morbidity and mortality in patients operated for typhoid ileal perforation

Typhoid perforation is the most important surgical complication of typhoid enteritis and is associated with a significant morbidity and mortality. To determine the factors affecting morbidity and mortality in patients with typhoid intestinal perforation, the complete medical records of a pool of patients from two major teaching hospitals of Lahore were reviewed. A total of 39 patients diagnosed to have typhoid Heal perforation at operation included 27 patients operated in the emergency of South Surgical Ward. Mayo Hospital Lahore from January 1998 to Dec 2000, and 12 consecutive patients operated by the surgical team of Surgical Unit II. Shaikh Zayed Medical Complex. Lahore between December 2000 to May 2005. The average age was 26 years, the male-to-female ratio 4/1. The mean interval from admission to operation was 09 hours [range 05 hours - 03 days]. Eight patients had more than one perforation at the time of operation. Primary repair of the perforation was performed in 22% of the patients, ileostomy [primary repair and proximal loop ileostomy or exteriorization of perforation as a loop ileostomy] in 46%. and resection with end ileostomy and mucous fistula in 32%. No primary end-to-end anastomosis after resection was performed. Postoperative complications occurred more commonly in patients with delayed admission and/or severe peritonitis. Hospitalization was shorter and the postoperative complication rate lower in patients who underwent ileostomy. Three patients developed an enter cutaneous fistula requiring re-operation. The four deaths [10.25% mortality] resulted from overwhelming sepsis. The most significant factors affecting morbidity were prolongation of perforation-operation interval and severe peritonitis. No single operative procedure is best in all cases: therapy should be individualized and tailor made for every patient. Ileostomy appears to be an effective and safe procedure, particularly in patients with severe abdominal contamination and delayed presentation. Early diagnosis, aggressive resuscitates tion with fluid and electrolyte optimization and prompt operation may result in improved survival in these seriously ill patients