Comparison between mesh fixation and non-fixation in patients undergoing total extraperitoneal inguinal hernia repair.

BACKGROUND: The most important advantages of laparoscopic hernia repair include less postoperative pain, good cosmetic results, and early return to daily activities. Different methods and mesh types are used in inguinal hernia repair. AIMS: The objective of this study was to evaluate the complications and recurrence rates in patients who underwent laparoscopic inguinal hernia repair with and without mesh fixation. SUBJECTS AND METHODS: A total of 183 patients who underwent total extraperitoneal (TEP) inguinal hernia repair in the general surgery clinic between January 2012 and January 2015 patients operated due to inguinoscrotal hernia and those lost to follow-up were excluded from the study. Patients were divided into two groups. Group 1 consisted of patients in whom 3D (Bard 3D Max) mesh was used and fixed with symphysis pubis absorbable tucker, while group 2 included patients without mesh fixation. All statistical analyses were performed using SPSS 22.0 statistical package software. The differences were considered statistically significant if the P value was less than 0.05. RESULTS: In the study, 178 patients were included. The median age was 48 years. Of all patients, 98 had right-sided, 72 left-sided, and eight bilateral hernias. The mean follow-up duration was 45 months. The demographic data between the groups were similar. Operation time was 51.82 ± 18.87 min in group 1 and 52 ± 19.92 in group 2 (P = 0.089). No statistically significant difference was found between both groups in terms of the development of early and late complications. Intraoperative complications, port-site hernia, and mortality were not seen in any patient. CONCLUSION: TEP seems to be a safe and effective surgical approach in inguinal hernia treatment with acceptable operation times and postoperative results. It was determined that not performing mesh fixation in the TEP application did not cause a statistical increase in morbidity and recurrence rates.

Does alvarado score reduce the need for ultrasonography in the diagnosis of acute appendicitis?

AIMS: We aimed to evaluate the correlation between Alvarado scoring and ultrasonographic findings in the diagnosis of acute appendicitis and its role in reduction of the rate of negative appendectomy. METHODS: A total of 2772 patients operated between January 2010 and September 2016 with the presumed diagnosis of acute appendicitis were retrospectively evaluated. Patients with appendicitis detected in histopathologic examination were assessed as Group 1, and those with no appendicitis detected were assessed as Group 2. RESULTS: The rate of negative appendectomy was 5.3%. Alvarado score was ≥7 in 2226 and <7 in 399 patients in Group 1. Alvarado score was ≥7 in 92 and < 7 in 55 patients in Group 2 (P < 0.0001). Among the patients with acute appendicitis identified in histopathologic examination, USG revealed acute appendicitis in 1804 and no acute appendicitis in 422 of the patients with an Alvarado score >7. Among the patients without acute appendicitis in histopathologic examination, USG revealed acute appendicitis in 74 and no acute appendicitis in 18 of the patients with an Alvarado score >7, while acute appendicitis was detected in USG in 29 and was not detected in 26 of the patients with an Alvarado score <7. CONCLUSION: While possibility of correct diagnosis is high in patients with an Alvarado score ≥7, the diagnosis should not be ruled out in patients with a low Alvarado score. Instead of using alone, the use of Alvarado scoring and ultrasonography together could reduce the rate of negative appendectomy and increase specificity.

Glisson's capsule cauterisation is associated with increased postoperative pain after laparoscopic cholecystectomy: a prospective case-control study.

INTRODUCTION Postoperative pain after laparoscopic cholecystectomy has three components: parietal, visceral and referred pain felt at the shoulder. Visceral peritoneal injury on the liver (Glisson's capsule) during cauterisation sometimes occurs as an unavoidable complication of the operation. Its effect on postoperative pain has not been quantified. In this study, we aimed to evaluate the association between Glisson's capsule injury and postoperative pain following laparoscopic cholecystectomy. METHODS The study was a prospective case-control of planned standard laparoscopic cholecystectomy with standardized anaesthesia protocol in patients with benign gallbladder disease. Visual analogue scale (VAS) abdominal pain scores were noted at 2 and 24 hours after the operation. One surgical team performed the operations. Operative videos were recorded and examined later by another team to detect presence of Glisson's capsule cauterisation. Eighty-one patients were enrolled into the study. After examination of the operative videos, 46 patients with visceral peritoneal injury were included in the study group, and the remaining 35 formed the control group. RESULTS VAS pain score at postoperative 2 and 24 hours was significantly higher in the study group than control (P = 0.027 and 0.017, respectively). CONCLUSIONS Glisson's capsule cauterisation in laparoscopic cholecystectomy is associated with increased postoperative pain. Additional efforts are recommended to prevent unintentional cauterisation.

Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases.

Introduction Cholecystectomy for benign gallbladder diseases can lead to previously undiagnosed gallbladder cancer during histopathological evaluation. Despite some controversy over its usefulness, histopathological evaluation of all gallbladder specimens is common in most hospitals. We evaluated the results of routine pathology of the gallbladder after cholecystectomy for benign gallbladder diseases with regard to unexpected primary gallbladder cancer (UPGC). Methods Patients undergoing cholecystectomy because of benign gallbladder diseases between 2009 and 2013 were enrolled in this study. All gallbladder specimens were sent to the pathology department, and histopathological reports were examined in detail. The impact of demographic features on pathological diagnoses and prevalence of UPGC assessed. Data on additional interventions and postoperative survival for patients with UPGC were collected. Results We enrolled 1,747 patients (mean age, 48.7±13.6 years). Chronic cholecystitis was the most common diagnosis (96.3%) and was associated significantly with being female (p=0.001). Four patients had UPGC (0.23%); one was stage T3 at the time of surgery, and the remaining three cases were stage T2. Conclusions Routine histopathological examination of the gallbladder is valuable for identification of cancer that requires further postoperative management.