Incisional hernia in women: predisposing factors and management where mesh is not readily available

Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria during a period when prosthetic mesh was not readily available. All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia [index] operations and possible predisposing factors. They all had open surgical repair and were followed up for 18-60 months. Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 [59.1%], emergency exploratory laparotomy 6/44 [13.6%], and elective surgeries 12/44 [27.3%]. Major associated risk factors were the use of wrong suture materials for fascia repair, midline incisions, wound sepsis, and overweight. For elective surgeries, reduction of weight should be encouraged when appropriate, and transverse incisions are preferred. Absorbable sutures, especially chromic catgut, should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases

Retroperitoneal and genital lymphangioma therapeutic challenges in a developing country

Lymphangiomas occur most commonly in the head and neck region, while other sites are rarely affected. A combination of retroperitoneal and genital lymphangioma is very rare indeed. Though congenital, it may persist into adulthood due to missed diagnosis and inadequate or total lack of treatment. A report of a 22-year-old male student who presented with recurrent multiloculated genital, thigh, groin and retroperitneal lymphangioma. He underwent surgical excision and adjuvant sclerotherapy using ethylene-diamine tetra acetic acid. There was an initial recurrence after surgery which responded satisfactorily to sclerotherapy. Complete surgical excision of lymphangioma may be precluded by vital structures but sclerotherapy produces satisfactory resolution. The difficulties in management with limited facilities for diagnosis and treatment are highlighted