Initial evaluation of Permacol bioprosthesis for the repair of complex incisional and parastomal hernias.

PURPOSE: Repair of complex hernias with synthetic mesh is associated with a significant complication rate, which may necessitate mesh removal. Recent studies have reported good results with the use of collagen-based prosthesis for complicated or infected abdominal hernias. The aim of our study was to evaluate an initial experience using Permacol for the repair of complex incisional and parastomal hernias. METHODS: A retrospective study of patients with massive, recurrent, complex, or infected incisional and hernias who underwent repair with Permacol at a tertiary referral centre was performed. RESULTS: Between 2003 and 2007, 15 patients underwent repair of complex massive or recurrent hernias with Permacol. Patients were followed up for a median of 377 days (range 85-1905). 16 postoperative complications developed in 11 patients. Two patients developed a recurrence and two patients developed fistulae. No patient has an active infection or required removal of the Permacol. There have been no deaths. CONCLUSIONS: There is increasing evidence that Permacol mesh can be safely used for complex and contaminated hernia repairs with acceptable overall results.

Inflamed appendix in a femoral hernial sac: de Garengeot's hernia.

Croissant de Garengeot's hernia is defined as the presence of an appendix in the femoral hernial sac. It is rare and occurs mostly in females. We report this hernia in a male patient along with the surgical management and review of literature.

Micropuncture cholecystectomy vs conventional laparoscopic cholecystectomy: a randomized controlled trial.

BACKGROUND: The aim of this study was to compare micropuncture laparoscopic cholecystectomy (MPLC), with three 3.3-mm cannulas and one 10-mm cannula with conventional laparoscopic cholecystectomy (CLC). METHODS: Patients were randomized to undergo either CLC or MPLC. The duration of each operative stage and the procedure were recorded. Interleukin-6 (IL-6), adrenocorticotropic hormone (ACTH), and vasopressin were sampled for 24 h. Visual analogue pain scores (VAPS) and analgesic consumption were recorded for 1 week. Pulmonary function and quality of life (EQ-5D) were monitored for 4 weeks. Statistical analysis was performed using the Mann-Whitney test or Fisher's exact test. Results are expressed as median (interquartile range). RESULTS: Forty-four patients entered the study, but four were excluded due to unsuspected choledocholithiasis (n = 3) or the need to reschedule surgery (n = 1). The groups were comparable in terms of age, duration of symptoms, and indications for surgery. Total operative time was similar (CLC, 63 [52-81] min vs MPLC 74 [58-95] min; p = 0.126). However, time to place the cannulas after skin incision (CLC, 5:42 [3:45-6:37] min vs MPLC, 7:38 [5:57-10:15] min; p = 0.015) and to clip the cystic duct after cholangiography (CLC, 1:05 [0:40-1:35] min vs MPLC, 3:45 [2:26-7:49] min; p <0.001) were significantly longer for MPLC. Six CLC patients and one MPLC patient required postoperative parenteral opiates (p = 0.04). Oral analgesic consumption was similar in both groups (p = 0.217). Median VAPS were lower at all time points for MPLC, but this finding was not significant (p = 0.431). There were no significant differences in postoperative stay, IL-6, ACTH or vasopressin responses, pulmonary function, or EQ-5D scores. CONCLUSIONS: The thinner instruments did not significantly increase the total duration of the procedure. MPLC reduced the use of parenteral analgesia postoperatively, which may prove beneficial for day case patients, but it did not have a significant impact on laboratory variables, lung function or quality of life.