Polypropylene-based composite mesh versus standard polypropylene mesh in the reconstruction of complicated large abdominal wall hernias: a prospective randomized study.

PURPOSE: To compare polypropylene mesh positioned onlay supported by omentum and/or peritoneum versus inlay implantation of polypropylene-based composite mesh in patients with complicated wide-defect ventral hernias. METHODS: This was a prospective randomized study carried out on 60 patients presenting with complicated large ventral hernia in the period from January 2012 to January 2016 in the department of Gastrointestinal Surgery unit and Surgical Emergency of the Main Alexandria University Hospital, Egypt. Large hernia had an abdominal wall defect that could not be closed. Patients were divided into two groups of 30 patients according to the type of mesh used to deal with the large abdominal wall defect. RESULTS: The study included 38 women (63.3 %) and 22 men (37.7 %); their mean age was 46.5 years (range, 25-70). Complicated incisional hernia was the commonest presentation (56.7 %).The operative and mesh fixation times were longer in the polypropylene group. Seven wound infections and two recurrences were encountered in the propylene group. Mean follow-up was 28.7 months (2-48 months). CONCLUSIONS: Composite mesh provided, in one session, satisfactory results in patients with complicated large ventral hernia. The procedure is safe and effective in lowering operative time with a trend of low wound complication and recurrence rates.

Ultrasonography in the diagnosis and management of 52 patients with amebic liver abscess in Cairo.

Clinical characteristics of 52 patients with amebic liver abscess are reported. Forty-two percent had an acute illness, usually with high fever, vomiting, sweating, pain in the abdominal right upper quadrant, and leukocytosis. The other 58% had a more chronic illness, usually with a dull ache in the right upper abdomen, weight loss, fatigue, moderate or low-grade pyrexia, and anemia. Hepatomegaly and hepatic tenderness were present in all patients; fever occurred in 75%. The diagnosis was strongly suggested by amebic antibodies in high titer and hepatic abscesses demonstrated by sonography. Mean abscess diameter was 9.2 cm; 37% were larger than 10 cm. Most abscesses were solitary (81%), in the right lobe (73%), rounded or oval (78%), cystic (57%), and had a well-defined wall (53%). However, 43% were initially solid or heterogeneous. The latter lesions always developed a cystic pattern when ultrasonography was repeated. The diagnosis was confirmed by a good clinical response to metronidazole in 50 patients. Complications included right-sided pleural effusions or empyema (13%), ascites (13%), and jaundice (13%). Drainage of large abscesses was performed in four patients. All 52 patients survived and were cured.