A Clinical Study on Epidemiology and Management of Incisional Hernia.

Incisional hernia is one of the common complications encountered following abdominal surgery and is an important cause of morbidity. It can be repaired by following anatomical, mesh or laparoscopic methods. The incidence of these hernias is high even with recent advances in surgery, anaesthesiology, antibiotics, and suture materials used. We wanted to study the epidemiology, aetiology, mode of presentations, modalities of treatment and its outcome, of incisional hernia.METHODSThis study was done from July 2017 and June 2019, 50 patients with incisional hernia who got admitted in the Department of Surgery at Sri Venkateshwaraa Medical College and Research Center, Ariyur were subjected to anatomical or mesh repair depending on the surgeon’s choice and size of defect. A total of 50 cases were studied and followed for a period of 6- to 18-months. Patients of age 12 years and above of both sexes who presented with incisional hernia post abdominal surgery were included in this study. Age below 12 years and those presented with other hernias like inguinal/ventral hernias were excluded. Data was collected and analysed by various statistical methods. RESULTSIncisional hernia was found to be the second most common type of hernia. The incidence was more common in females, who underwent gynaecological procedures by lower midline incisions. It was found to be more common in the age group 30-60 years. Predominant risk factors being wound infection and obesity. Infraumbilical midline incision (50%) was found to be more common compared to other incisions. Majority of patients who underwent emergency surgery developed incisional hernia. Postoperative complications noted were mainly due to wound infections and seroma.CONCLUSIONSMesh repair results in less recurrence than anatomical repair for incisional hernia. The incidence of incisional hernia is more common in women than men due to abdominal wall weakness secondary to multiple pregnancies, increased number of caesarean sections and gynaecological surgeries. Sterile aseptic technique and appropriate use of pre-operative antibiotics is necessary to reduce the occurrence of incisional hernia.

Anatomical Repair for Chronic Lateral Ankle Instability / 대한정형외과학회잡지

Ankle sprain secondarily leads to chronic lateral ankle instability in 20%-30% of cases. Many surgical procedures have been presented for lateral ankle instability; however, controversy remains regarding the ideal surgical option. The Brostrom procedure or its modifications have been widely used; however, they have some limitations for the instabilities of over-weight, physically high demanding patients, generalized ligamentous laxity, and especially for significantly deficient or attenuated ligaments. This article reports on the difference between the bone tunnel technique and the suture anchor technique of the modified Brostrom procedure, and also provides a review of several recent debates.

Outcome and Preoperative Predictive Factor after Complete Anatomical Repair in Perineal Obstetric Injury

PURPOSE: To assess the outcome of complete anatomical repair (sphincteroplasty, rectal wall plication, rectovaginal septum plication, perineal body repair, levatoroplasty) and to identify the preoperative factors influencing the outcome for the perineal obstetric injury. METHODS: Eighteen, consecutive female patients who had undergone complete anatomical repair with chronic fecal incontinence due to perineal injury during 13 months were evaluated. Mean age was 48.9+/-10.1 years, mean duration of symptom was 18.9 (range: 1-33) years, mean delivery numbers were 2.8 +/-1.2 times, and mean follow up was 11.9 +/- 4.7 months. The predictive factors were age, manometry, PNTML (pudendal nerve terminal motor latency), rectal sensation, RAIR (rectoanal inhibitory reflex), duration of symptom, angle of sphincter defect, vaginal delivery numbers, hospital stay, follow-up period, wound healing period, and Wexner's incontinence score. RESULTS: The anatomical success rate via endoanal ultrasonography was 100%, complication rate was 5.5%, and functional success rate (Wexners' score < or =5) was 88.9%. The patients showed lower maximal resting pressure, maximal squeezing pressure, maximal voluntary contraction, mean resting pressure, mean squeezing pressure, and maximal tolerable volume than the normal control group (p<0.05). The median incontinence score was significantly decreased after surgery (pre op=12.2 vs post op=2.9) (p<0.05). Among the preoperative predictive factors, the incontinence score correlated significantly with postoperative functional success (r=0.552, P=0.017). CONCLUSIONS: Complete anatomical repair showed an excellent anatomical result and a good functional outcome. Patient with high preoperative incontinence score had a tendency for postoperative residual incontinence.

Anatomical Repair of Massive Rotator Cuff Tear / 대한정형외과학회잡지

PURPOSE: We evaluate the possibility of the anatomical repair of massive rotator cuff tear and review the clinical results. MATERIALS AND METHODS: From March 1995 to June 1999, twenty-six cases of massive rotaor cuff tear were reviewed with minimal followup of one year. The clinical results were evaluated using ASES (American Shoulder and Elbow Surgeons) score. RESULTS: Twenty two cases (85%) showed satisfactory results, 8 excellent results (31%) and 14 good results (54%). There were four cases (15%) of unsatisfactory results, two cases of fair and two cases of poor results. Mean value of the ASES score increased from 41 (14-60) points to 83 (46-98) points. Mean value of the increased score was 42 (20-76) points. There were no cases of functional deterioration or revision surgery. CONCLUSION: Anatomical repair was considered to be practically possible in the majority of cases of massive rotator cuff tear as an initial treatment.