Is the self-adhesive mesh a solution for chronic postoperative inguinal pain after TAPP: A single centre preliminary experience?

BACKGROUND: Minimally invasive surgery for groin hernia has expanded significantly over the last two decades and has demonstrated better outcomes in terms of pain and quality of life. A major contributing factor related to chronic post-operative inguinal pain (CPIP) is mesh fixation. An alternative to the standard fixation methods is the self-adhesive surgical mesh. PATIENTS AND METHODS: Prospective data analysis was performed of all patients undergoing laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair in a single centre for the period 1 st January, 2022-15 th December, 2022. A standardised surgical technique was used with a lightweight self-adhesive mesh without additional fixation. The analysis has encompassed early and late post-operative complications as well as the assessment of pain with an emphasis on CPIP. RESULTS: The study enrolled 52 patients where a total number of 64 elective hernia repairs were performed: 92.2% ( n = 59) primary and 7.8% ( n = 5) recurrent. Fifty-one patients received post-operative follow-up: 100% at 1 month and 78.8% ( n = 41) at 3 months. The incidence of early postoperative complications was 7.7% ( n = 4): one patient developed a seroma, two patients - port site hematomas and one a transient subileus that were all managed conservatively. No patients suffered a recurrence. The average pain score according to the Visual Analogue Scale was 3.3 (0-8) at discharge, 0.6 (0-4) at 1 month and there was no incidence of CPIP after the 3 rd month. CONCLUSION: Laparoscopic TAPP repair for inguinal hernia with a self-adhesive mesh is an adequate surgical technique with the potential to reduce CPIP, but more research is needed to evaluate this method.

COVID-19 in Liver Transplant Recipients - Preliminary Experience of a Bulgarian Center.

Introduction: There are still debatable facts about estimating the risk and severity of coronavirus disease (COVID-19) in liver transplant recipients, as well as assessing the impact of the immunosuppressive therapy on the clinical course and incidence of liver failure. Material and Methods: We present a prospective study of liver transplant recipients with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection admitted for treatment to the department of First Clinic of Abdominal Surgery, Military Medical Academy, Sofia during 25.11.2020 04.01.2021. The diagnosis is confirmed by a positive reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection from a naso-pharyngeal swab. COVID-19 severity is estimated as mild (oxygen saturation (SpO2) 94% on room air and no imaging findings of pneumonia), moderate (SpO2 94%, imaging suggestive of pneumonia), and severe (need for high flow oxygen supplementation). Results: Three liver transplant recipients with COVID-19 were admitted and treated in our department during 25.11.2020 04.01.2021. All of them were male, mean age of 51.33 years (47 - 59) and their liver transplantations were performed 13, 5, and 1.5 years before. In each of the three patients a different clinical form of the disease was registered mild (n=1), moderate (n=1), and severe (n=1). Only the patient with severe disease had comorbidities - hypertension, diabetes, and obesity. The patients with mild and moderate disease received dual immunosuppressive therapy with tacrolimus and mycophenolate mofetil while the one with severe disease - tacrolimus only. A dose reduction of tacrolimus was undertaken following serum level evaluation without changing the dose of the mycophenolate mofetil for those on dual therapy. The patient with severe disease died from respiratory failure leading to a case fatality rate of 33.3%. Conclusion: Early diagnosis and hospitalization where possible are essential for the prompt initiation of treatment, prevention of complications and development of severe forms of COVID-19 in liver transplant recipients, especially in patients with comorbidities such as hypertension, diabetes, and obesity. During the course of treatment there may be a dose reduction of the immunosuppressive therapy but not discontinuation, especially of the calcineurin inhibitor in mono- or dual-therapy regimens.

Tension pneumoperitoneum.

A 35-year-old man stopped breathing after injecting a large dose of heroin. He subsequently received cardiopulmonary resuscitation from friends. He arrived to accident and emergency department with Glasgow Coma Scale of 13. On examination, he had distended and tense abdomen. CT Thorax, Abdomen, and Pelvis confirmed massive tension pneumoperitoneum. A 14 Fr intravenous cannula was inserted through the umbilicus to relieve the intra-abdominal pressure. An emergency laparotomy showed petechia along the anterior gastric wall, haematoma of lesser omentum but showed no evidence of gastrointestinal perforation or organ injury. Air leak test performed by insufflating air into the stomach via nasogastric tube and abdomen filled with normal saline showed no leak. On-table oesophagogastroduodenoscopy showed mild oesophagitis and petechia of cardiac gastric mucosa. He was treated with intravenous antibiotics and discharged on the fifth postoperative day with adequate analgesia.