Repair of parastomal hernia associated with incisional hernia and pendulous abdomen

Parastomal hernia [PSH] represents one of the difficult challenges for the surgeon. The association of incisional hernia [laparocele] and parastomal hernia adds to the novel of the issue especially if the abdomen is pendulous. The aim of this study is to evaluate a surgical treatment plan for such complex situations. Seventeen patients with parastomal hernia around a permanent stoma associated with laparocele and pendulous abdomen were selected for the study. They were 11 males and 6 female with a mean age of 53 +/- 9 years. After preoperative assessment, they were subjected to relocation of the stoma plus reinforcement of the laparocele repair and the old stoma site with onlay proparietal polypropylene mesh together with dermolipectomy. The overall complications were encountered in three patients Wound infection was reported in the 3 cases [17.7%], seroma in 2 [11.8%], minimal flap necrosis in 2 [11.8%] sinus formation in one patient [5.9%] and development of PSH at the new site in two patients 11.8%. The association of parastomal hernia, incisional hernia and pendulous abdomen jeopardizes the patient's quality of life and surgery is often indicated. The repair by relocation and reinforcement with onlay polyproplene mesh together with dermolipectomy represents a good solution in terms of low morbidity and an acceptable final outcome

Gastropexy for chronic gastric volvulus: a new technique with long-term follow-up

A case of chronic gastric volvulus is reported where gastropexy to both the abdominal wall and the diaphragm was achieved by a double row, an inch apart, of interlocking silk sutures. The postoperative course was uneventful and the symptoms were completely relieved. Barium meal 49 months after surgery showed normal shape, size, position and peristalsis of the stomach. Follow-up period is 6.5 years. This form of gastropexy is suitable for all types of primary gastric volvulus

reappraisal of the role of the cross-leg flap

This study includes twenty patients treated by [cross-leg] flaps. The indication for operation was chronic traumatic ulcer in 15 cases, scarring and deformity in two cases; irradiation dermatitis with ulceration, post-burn ulcer and vulnerable scar in one case each. There were 17 excellent results [85%] where the flap had completely taken with no loss whatsoever nor ulceration. Postoperative oedema of the flap occurred in 3 of these patients, who had not followed instruction, but was cured in all. Two of the cases required defattening before the outcome could be labeled [excellent]. A [very good] result occurred in 3 cases [15%]. In these 3 patients an excellent result could have been achieved with greater attention to detail. Four cases are reported and 3 of these are taken to illustrate the fact that there may be no other alternative to the [cross-leg] flap. The [cross-leg] flap should therefore retain its place in the surgeon's armamentarium

Skin graft replacement of the nail bed: a radical treatment for onychomycosis of the big toe

Skin graft replacement of the nail bed of the big toe was used in 3 patients with onychogryposis [6 toes] and in 12 patients with onychomycosis [14 toes] with excellent results. The procedure is a simple outpatient one. Symptoms are cured, the cosmetic appearance is satisfactory and prolonged antifungal treatment is not necessary. We strongly recommend this treatment for cases with advanced onychomycosis affecting the big toe in which other methods have failed

localisation of bilharzial bladder carcinoma by ultrasonography

This is a study of 51 patients with Bilharzial bladder carcinoma whose investigations included bimanual examination under anaesthesia, invtravenous urography, cystoscopic biopsy and ultrasonography. There were sixteen T[2], thirty-one T[3] and four T[4] tumours. All patients were operated upon and the ecised specimens were xamined pathlogically. Three ultrasonopraphic examination failures occurred due to extreme urinary urgency resulting in a very poorly distended bladder [5.9%]. In the remaining 48 patients, the sites of the tumour were the lateral walls [18], posterior wall [15], anterior wall [6], vault [7] and trigion [2]. The smallest tumour size was 2.5 cm. The limits of the different bladder regions in sagittal ultrasonography were defined and a diagrammatic guide was evolved which has allowed shortening of the examination time to no more than five to ten minutes. This should lead to decrease of the examination time when ultrasonograpy is used in staging bladder carcinoma. The accuracy of our results and the short time involved in performing the examination combined with the facts that ultrasonography is non invasive and that the apparatus used is capable of resolving objects as small as 0.5 cm in size lead us to suggest that ultrasnography should be tried as a screening method for Bilharzial carcinoma in high risk idividuals

Prevention of postoperative peritoneal adhesions: an experimental study

For this study, 36 rats were divided into 6 equal groups. In the control group, a midline abdominal incision was performed and the intestines roughly maniplulated by gloves, heavily dusted with tale powder. In group [II] the operator's gloves were thoroughly washed in sterile to remove the talc powder. In group [III] peritoneal lavage was done using sterile physiological saline. In group [IV] prednisolone tertiary butyl acetate suspension 5 mg/kg body weight diluted in saline 10 ml/Kg body weight was applied intraperitoneally. In group [v] intraperitoneal dexamethasone phosphate 1 mg/kg body weight diluted in saline 10 ml/kg body weight was used. In group [VI] prednisolone oily solution 5 mg/kg body weight was given intramuscularly during the operation. Three rats of ach group were sacrificed at the end of one week and the other 3 at 4 weeks. The presence and degree of peritoneal adhesions and granulomas were recorded. The results of this study suggest that in addition to thorough washing of the operator's gloved hands by sterile water or saline before laparotomy and the preoperative use of peritoneal lavage with saline, steroids applied intraperitoneally in solution or suspension form may have a role in the prevetion of peritoneal adhesions