Paraumbilical hernia repair during cesarean delivery

Pregnant women with paraumbilical hernia usually postpone hernia repair until after delivery, but some patients request that it be done during cesarean delivery. Therefore, we evaluated the outcome of combined cesarean delivery and paraumbilical hernia repair in a prospective study at a tertiary referral university hospital. In a prospective study, we compared the outcome of 48 patients undergoing cesarean delivery combined with paraumbilical hernia repair versus 100 low-risk patients undergoing cesarean delivery alone. The main outcome measures were operation time, blood loss, severity of pain, peripartum complications, hospital stay, hernia recurrence, and patient satisfaction. The combined procedure took significantly longer than cesarean delivery alone [75.2 minutes versus 60.5 minutes, P < .001]]. There were no major complications. Wound infection occurred in 6 patients [4.1%]. Hospital stay did not differ significantly from those of controls. Pain at the hernia site repair occurred in two patients, and one hernia recurred in the hernia repair group during a mean follow-up period of 22 months [range, 6-36 months]. All hernia patients reported that they preferred the combined operation. Combined cesarean delivery and paraumbilical hernia repair had the advantage of a single incision, single anesthesia, and a single hospital stay while avoiding re-hospitalization for a separate hernia repair. Our results indicate that the combination approach is safe, effective, and well accepted

Results of senning operation modified with wide-based pericardial graft [an echocardiographic evaluation]

Despite the fact that the arterial switch operation is the treatment of choice for complete transposition of the great arteries, patients with unbalanced ventricles still needs the Senning operation. Known surgical complications like baffle obstruction may result in early deterioration of ventricular function and impaired exercise performance. It is not clear wether these complications are inevitable or predisposing factors at surgery or during follow up may identify patients at high risk Baffle obstruction after Senning operation may result in early deterioration of RV function and impaired exercise performance. The Objective was to assess the effect of surgical modification in avoiding surgical complications with its deleterious effects on early as well as late follow up. Echocardiography was used to assess postoperative outcome. This prospective study included 30 cases who were candidates for Senning operation for simple transposition of great arteries in the cardiothoracic department of Aboul-Reesh Pediatic hospital Cairo University where an in-situ wide-based pericardial patch was used for the outer baffle, modified right atriotomy and suture lines were modified in all patients. Left atrial appendage augmentation was used in 8, Eustachian valve in 6 cases. Postoperatively patients were subjected to clinical evaluation using Ross scoring for heart failure, ECG and echocardio graphic evaluation to assess RV size, degree of TR, baffle patency, LVOT dynamic obstruction, and global RV systolic and diastolic functions using the myocardial performance index [MPI]. We had early 2 mortalities [6.66%] out of low cardiac output, accelerated nodal rhythm was experienced in other 2 patients [6.66%], internal baffle pressure was 6.1 +/- 2.64cc H20. Data higher than 12cc H[2]O was found in 3 patients [10%], none of them had augmentation with the left appendage. Outer baffle pressure was 9.2+ 1.08 cc H20. No baffle leakage was detected. Clinical examination postoperatively revealed that only one patient had four points on Ross score of HF and the rest of patients had a zero score. Nodal arrhythmias were found in three patients, marked RV dilatation was found in one case and the other 27 cases had mild dilatation, moderate TR was present in 4% of cases, mild TR in 72% of cases. There was no baffle obstruction or LVOT obstruction in our patients. Patients who had Senning operation after the first year of life [40%] had RV MPI more than 0.4 while those under the first year [60%] had MPI less than 0.4. Baffle Augmentation with the wide based pericardial patch offered less chance for baffle obstruction, Left atrial appendage could be used in addition to offer an additional tool to avoid higher internal baffle pressures. Patients subjected to Senning operation earlier in the first year of life and patients have higher oxygen saturation at the time of the operation have better global RV functions