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Article
PEDIATRIC INGUINAL HERNIA IN BASRAH

Authors: Sadik H Kadhem --- Haithem H Ali --- Haider A Jassim
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2015 Volume: 21 Issue: 2 Pages: 61-65
Publisher: Basrah University جامعة البصرة

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Abstract

Abstract Inguinal hernia repair is one of the most frequently performed surgical procedure in pediatric patients. An inguinal hernia does not resolve spontaneously and must be repaired because of high risk of complications. The aim of this study is to determine epidemiologic index and complications of inguinal hernia in pediatric patients. This retrospective study was carried out in the Basrah Children Hospital. All patients who underwent surgeries for inguinal hernia from 2012 to 2014 were included in this study. Their hospital records were reviewed for age, sex, side of the hernia, presentation, wound infection, recurrence, and other complications. In this study, 877 children were included. 766 (87.3%) were boys and 111 (12.7%) were girls. Most common age of presentation is between 6 months to 6 years which compromise 54.6%. Right-side and left-side inguinal hernia was observed in 531 (60.5%) and 276 (31.5%) cases, respectively. Bilateral inguinal hernia was observed in 70 (8%) cases. One hundred forty eight (16.9%) children presented as emergencies with irreducible hernia. Emergency presentation was more in male gender and more in the first 6 months of life. Postoperative complication rate for elective was 3.2% and for emergency groups was 51.7%. In conclusion, most of the hernias involved male patients. Postoperative complications were observed in 51.7% of the emergency cases, so inguinal hernia in children should be operated as early as possible to avoid incarceration and to decrease post-operative complications.


Article
ANTHROPOMETRIC STUDY OF PUBIC TUBERCLE AND ITS CLINICAL IMPLICATIONS

Author: Thaer M Farhan ثائر محمود فرحان
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2011 Volume: 9 Issue: 4 Pages: 308-311
Publisher: Al-Nahrain University جامعة النهرين

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BackgroundAbdominal wall is the site of opposing physical forces that may eventually result in the appearance of the hernias. The external abdominal hernias are the most common forms, the inguinal hernia being the commonly encountered type [75% of the abdominal hernia]. Many factors are responsible for the formation of the inguinal hernia but, what makes a few people more susceptible to this situation is still clearly not proved. Few of the previous studies have concluded that the low lying pubic tubercle is associated with the development of the inguinal hernia.ObjectivesThis study was designed to investigate the distance between the anterior superior iliac spines and the perpendicular distance of the pubic tubercle from the interspinal line.Methods50 males with inguinal hernia compared with the control group comprising of 60 adult healthy males.ResultsThis study revealed that both parameters (interspinal SS distance and the pubic tubercle height ST) in the study group were significantly greater than that in the control group. The distance from mid inguinal point to the superficial inguinal ring was also measured in both the study and control groups and the results show that the distance is shorter in the individuals with the inguinal hernia. Identification of the structural characteristics of inguinal region enables the surgeon to perform the surgical technique appropriately.ConclusionThe low pubic tubercle group of cases has more tendencies for herniation. The unusual origin of internal oblique muscle in group II with low lying tubercle is far away, from the external half of the inguinal ligament, leaving the internal ring unprotected during abdominal muscle contraction, which is another causation of hernia development.Key words Inguinal hernia, pubic tubercle, inguinal canal, anterior superior iliac spine


Article
Tension –Free Inguinal Hernia Repair Comparing 'Mesh' with 'Darn' A Prospective Randomized Clinical Trial

Authors: Ali M.Al-Saiegh --- Raad S. Al-Saffar --- Haider T. Al-Khassaki***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 220-227
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Lichtenstein tension free hernioplasty(mesh repair) and Moloney darn repair are commonly practiced repairs for inguinal hernias with acceptably low recurrence rates. Mesh repair is considered more recent than darn repair and both of them are tension free.OBJECTIVE:To compare the number of postoperative complications and early recurrence between Mesh repair and Darn repair, for inguinal hernia.PATIENTS AND METHODS:The study was conducted at Department of Surgery, Al-Sadur teaching hospital in An-Najaf from 1st august 2007 to 1st august 2008 . A total of 104 patients were selected. 51 patients were treated with Lichtenstein tension free hernioplasty (Group A) and 53 with Darn repair (Group B). Cases were followed up for three months to one year. The study design was quasi experimental.RESULT:The male to female ratio was 51:1. The mean hospital stay was 37.18 hours in group A and 47.17 hours in group B. there was statistically significant difference between the groups ( p< 0.05).The mean operative time was 44.7 minutes in group A and 50.9 minutes in group B. There was statistically significant difference between the groups ( p< 0.05). the The total number of postoperative complications was reported in 36 patients, 15 ( 29.42%) complications occurring in group A and 21( 39.62%) in group B. Scrotal swelling was the most common complication followed by urinary retention and wound infection in both study groups. Postoperative complications like scrotal swelling ( 11.77% vs. 16.98%), haematoma ( 5.88% vs. 3.77%), urinary retention (5.88% vs. 9.43%), wound infection ( 1.96 vs. 7.55%) and scar pain ( 3.92% vs. 1.89%) were unsignificantly low in Lichtenstein tension free hernioplasty as compared to Darn repair (P > 0.05). There were no recurrences noted till date in any of the two groups under study.CONCLUSIONOpen inguinal hernia repair with a nylon darn was equivalent to polypropylene mesh with respect to early measures of postoperative outcome and recurrence at 1 year. The mesh was superior to darn in operative time and hospital stay

Keywords

inguinal hernia --- mesh --- darn --- repair.


Article
Proline Mesh (Patch And Plug) Repair Of Inguinal Hernia Under General Versus Local Anaesthesia : Early And Long-Term Outcomes

Author: Jawad Kadhim Al-Dhahiry جواد كاظم الظهري
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2014 Volume: 10 Issue: 18 Pages: 71-77
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background: There is minimal data regarding the feasibility of Proline (patch and plug) inguinal hernia repair under local anaesthesia and patient acceptability.This study compares outcomes of Proline ( patch and plug) inguinal hernia repair under local anaesthesia versus general anaesthsia . Place and Duration of Study: The study was conducted in Department of Surgery,Al-Karama Teaching Hospital,Medical college/Wasit University,Iraq ,from 1st Faruary 2008 to 30th June 2012 and included 124 male patients. Follow-up period ranged from 6 months to 53 months .Study Design: The study design was a prospective study.Methods: This is a prospective study ,included 124 male patients(female patients were not included in this study ) with inguinal hernias that were repaired with Proline (patch and plug) over a 4.5 year period. The outcome (parameters) measures were, the type of anaesthesia used, early and late postoperative complications, and the patient satisfaction. Results: One hundred twenty four inguinal proline mesh hernioplasties were analyzed. Eighty two hernioplasties were performed under local anaesthesia (group A) and fourty two were performed under general anaesthesia (Group B). Patients with a body mass index >30 were 17 (14%) of group A and 8 (6%) of group B, respectively, (p = 0.7). Day cases were higher in the local-anaesthesia group (75 days vs. 16 days, p = 0.001). Early complications were similar in the two groups. 18 (26%) patients in the local anaesthesia and 6 (19%) in the general anaesthesia developed chronic groin pain (p = 0.6). One recurrence was noted in the local anaesthesia group. Patient satisfaction was high with both anaesthetic techniques. Conclusions: Proline (patch and plug) inguinal hernia repair under local anaesthesia resulted in increased day cases with similar complication rate when compared to general anaesthesia. Both anaesthetic techniques were associated with good outcomes and excellent patient satisfaction.

هنالك معلومات وبيانات قليلة حول جراحة الفتوقات المغبنية باستخدام شبكة البرولين تحت التخدير الموضعي والتخدير العام. تمت الدراسة خلال فترت اربع سنوات ونصف السنة في مستشفى الكرامة التعليمي في مدينة الكوت ,من الاول من شباط 2008 الى الثلاثين من حزيران 2012 واحصيت النتائج من مجموعة التخدير الموضعي وقورنت بمجموعة التخدير العام من حيث المضاعفا ت المبكرة والمتاخرة ونسب رجوع الفتوق, فوجدت النتائج متماثلة من حيث المضاعفات المبكرة والمتاخرة للمجموعتين مع زيادة مهمة بعدد الحالات التي تجرى تحت التخدير الموضعي ويتم اخراج المرضى من المستشفى في نفس اليوم مع موافقة و قبول من قبل المرضى من حيث طرق التخدير .فترة المتابعة تراوحت ستة اشهر – الى-ثلاثة وخمسين شهرا .


Article
Is it essential to put a drain in patients with Cholecystectomy?
حصيلة اصلاح الفتق المغبني بواسطة الشبكة. سلسلة حالات مكونة من ستة وتسعون مريض

Author: Hayder Assim حيدر عاصم
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2012 Volume: 2 Issue: 1 Pages: 84-90
Publisher: Diyala University جامعة ديالى

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Abstract

Background: Improvements in surgical technique for hernia repair, together with the development of new prosthetic materials and a better understanding of how to use them, have significantly improved outcomes for many patients.Objectives: In this case series we aimed to determine the acceptability, practicality, effectiveness, and safety of inguinal hernia repair using Lichtenstein tension-free mesh repair in Iraq.Patients and methods: Ninety-six adult patients with inguinal hernia were included in this study. The age range of patients was 20-70 years. The study was conducted in Al-Karama Teaching Hospital-Baghdad for the period from October 2002 to October 2009. Herniae were repaired with Prolene mesh as a tension-free Lichtenstein-style. All patients had prophylactic antibiotics, and were followed for surgical wound infection, induration, pain, recurrence, and other complications. Three (3.1%) Surgical operations were done entirely under spinal, and one (1.0%) under epidural anesthesia. Results: All the procedures were completed safely. No patient had complications directly attributable to or affecting the implanted mesh. One patient developed infection treated by antibiotic. No recurrence occurred during a maximum follow up period of seven months. Seroma occurred in two cases (2.0%), one patient had the procedure after failure of laparoscopic repair, and no removal of the mesh was needed during this period. Most of the patients were discharged on the next day or on the same day.Conclusions: Lichtenstein tension-free mesh repair appears quite acceptable, practical, effective and safe for inguinal hernia repair in our environment.

تمهيد: في سلسلة الحالات هذه، وللفترة من تشرين الاول 2002 ولغاية تشرين الاول 2009، كان هدفنا هو معرفة مقبولية وجدوى وفاعلية وسلامة اصلاح الفتوق المغبنية بطريقة زراعة الشبكة الجراحية في العراقالمرضى وطريقة العمل: ستة وتسعون مريض باعمار تتراوح بين العشرين سنة والسبعين سنة اجريت لهم هذه العملية. جميع المرضى استلموا مضادات حيوية وقائية، وتمت متابعتهم من ناحية، التهابات جرح العملية، الالم، رجوع الفتق، وأية مضاعفات او اختلاطات اخرى. ثلاثة مرضى (3,1%) تم اجراء التداخل الجراحي لهم تحت تاثير التداخل الشوكي، وحالة واحدة (1,0%) تحت تاثير تخدير فوق الجافية.النتائج: كل العمليات تمت بدون مشاكل خلال فترة العملية، لم يعاني أي مريض من اختلاطات ذات علاقة مباشرة او اثرت على زرع الشبكة، مريض واحد عانى من التهاب في جرح العملية تمت معالجته بواسطة المضادات الحيوية، لم تلاحظ حالات رجوع للفتوق خلال فترة المتابعة، سيروما حدثت في حالتين (2,0%)، مريض واحد اجريت له العملية بعد فشل في محاولة اصلاح الفتق بواسطة الناظور الجراحي، ولا توجد أي حالة احتاجت الى رفع للشبكة بعد زراعتها، معظم المرضى تم اخراجهم من المستشفىفي اليوم الذي يلي يوم اجراء العملية، قسم منهم تم اخراجهم في نفس اليوم.الاستنتاجات: وجدنا بانه زراعة الشبكة هي طريقة مقبولة، عملية، وفعالة، وأمينة لعلاج واصلاح الفتوق المغبنية في ظروفنا البيئية مع الاخذ بعين الاعتبار بان تكاليف وسعر الشبكات لم تدخل ضمن الدراسة، كذلك اجراء دراسات مستقبيلة ولعينات اكبرهي من ضمن الاحتياجات لاجراء مقارنة بين نتائج زراعة الشبكة الجراحية والطرق التقليدية لاصلاح الفتوق المغبنية وبموضوعية اكثر في ظروفنا البيئية.


Article
Sub- Inguinal Varicocelectomy in the Treatment of Infertile Males with Varicoceles

Author: Murtadha M.S.Majeed Al-Musafer
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 323-327
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Varicocele is an abnormal dilatation of pampiniform plexus within the spermatic cord. Varicoceles are present in 15% of the normal male population and in up to 35-40% of patients with infertility. In approximately 70-81% of patients with secondary infertility, a varicocele is an underlying cause. It is a disease of puberty and is only rarely detected in boys less than ten years of age.OBJECTIVE:Is to evaluate the sub inguinal approach of varicocelectomy in infertile males with grade II and III varicoceles.METHODS:A total of 150 patients were included in the study from 2004 to May 2010. Their ages ranged from 18 to 42 years. Fifty patients (33.3%) had grade II while 100 (66.6%) patients had grade III varicoceles. All the patients had history of more than one year infertility (ranging from 14 to 36 months) and all of them were sexually competent. Physical examination was performed with no apparent other clinical cause of infertility. Although varicoceles were diagnosed primarily by physical examination, color Doppler ultrasound was done for further documentation of the patient's condition. Only patients with grade II and grade III primary varicoceles were included in the study with exclusion of those with grade I varicoceles. Seminal fluid analysis and hormonal assay were done for all patients. Any patient with sperm concentration below 10 millions / milliliter was also excluded. Sub inguinal varicocelectomy was done for each patient. The operative time ranged from 20-25 minutes. The patients were followed for one year.RESULTS:The overall pregnancy rate at one year was 66, 6 % .The time from the operation till pregnancy was ranged from 4 to 12 months. Ten patients ( 6.6% ) developed recurrence , 2 patients ( 1.3% ) developed scrotal pain for 3 weeks postoperatively and then disappeared , and only 4 patients ( 2.6 % ) developed hydrocele .CONCLUSION:Whereas most male infertility surgeons now use the microsurgical approach, varicocele repairs can be achieved with successful results and minimal complications without microsurgery as long as they are carefully performed. Although microscopic sub inguinal varicocelectomy is better than non microscopic one, the later can be done successfully with shorter operative time


Article
Using mesh hernioplasty to patient with inguinal Hernia

Author: Fadhil A. Mohialdeen
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2012 Volume: 8 Issue: 14 Pages: 32-43
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

To clinically evaluate the outcome of Inguinal Hernioplasty in terms of haematoma, wound infection and recurrence, with special reference to surgery done by trainee surgeons. A total of 50 patients with inguinal hernia were operated during the study period. The result of the present study concluded that using mesh for surgical operation of hernia is much better than the ordinal operation of hernia because this technique reduces the recurrence of the disease, while the classical operation is related to recurrence of the disease. Also Mesh can reduce the appearing of hematomas, Wound infections after the operation, while the classical operation is related to appearing of the hematomas and Wound infections after the operation. Further more there is no significant difference between the two methods regarding appearing of seromas after the operation however, its appear among those patients which did a classical operation more than those which using mesh for operation. So In our set-up Mesh Hernioplasty has proven to be effective with low complication and recurrence rates.

يهتم البحث في تقييم النتائج السريرية لعمليات ترقيع الفتق الأربي من حيث التجمع الدموي ,خمج الجروح، وامكانية تكرارالفتق مجددا، مع إشارة خاصة إلى العمليات الجراحية التي يتم اجرائها من قبل الجراحين المتدربين. لقدتم اجراء ما مجموعه خمسون عملية للمرضى الذين كانو يعانون من فتق أربي خلال فترة الدراسة. واستخلص نتيجة لهذه الدراسة أن استخدام الشبكة(mesh) في عملية ترقيع الفتق هو أفضل بكثير من العملية التقليدية و يقلل من تكرار لهذا المرض، في حين ترتبط هذه العملية الكلاسيكية إلى تكرار لهذا المرض. أيضا يمكن أن تقلل من ظهور القيلة ،و خمج الجروح، في حين ترتبط العملية الكلاسيكية إلى ظهور التجمعات الدموية والتهابات الجروح ما بعد العملية. ليس هناك فرق كبير بين الطريقتين فيما يتعلق بظهور المصول seromas) ).


Article
Dermoid Cyst of the Spermatic Cord : a Rare Case of Benign Inguinal Lump

Authors: Mohammed Hillu Surriah --- Quttiba Abd-ul-Razaq Muneer
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 315-320
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

Dermoid cyst of the spermatic cord is an extremelyrare pathological state seen at the general surgeryand the urological clinic. We present a case of a19-year old male who presented with a painlessleft groin lump, irreducible, and no cough impulsefrom childhood, both testes presented in thescrotum and normal in size and shape. From the history, physical examination, ultrasoundexamination, we thought it was a lipoma , ahydrocele of the spermatic cord, or irreducibleinguinal hernia. During the operation , suspicion of a dermoid cystof spermatic cord occurred from a sebum and hair which discharged from the cyst during dissectionof the cyst from spermatic cord. The final histopathological analysis established thediagnosis of dermoid cyst of spermatic cord.


Article
Intrathecal Ketamine Versus Bupivacaine for Inguinal Hernia Surgery

Author: Aimen Hameed Latef
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 4 Pages: 477-481
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Ketamine shows beside its general anesthetic effect, a local anesthetic - like action; that is due to blocking of Na+ channels mainly with other proposed mechanisms.OBJECTIVE:Comparison of ketamine local anesthetic action with that of bupivacaine in neuraxial blockage (spinal anesthesia) was done.PATIENTS AND METHODS:Hundred patients were scheduled according to American Society of Anesthesiologists (ASA) physical status classification I-II for elective inguinal hernia surgery under spinal anaesthesia, divided into 2 equal groups, the first group received 2 ml (0.5%) bupivacaine, second group received 2 ml [75 mg preservative free Ketamine (1.5 ml) mixed with 0.5 ml, 30%dextrose], comparison in the onset, duration of the sensory block and the central sedative effect between the two groups was done.RESULTS:Group II patients who received ketamine intrathecally demonstrated faster onset of block with longer duration of analgesia, 30% of them appeared sedated owing to the central sedative effect.CONCLUSION:As a new look to an old drug; ketamine can be used as a pure local anesthetic for spinal anesthesia with the advantage of longer period of analgesia and faster onset as compared with bupivacaine. Ketamine group appeared more hemodynamically stable.


Article
A Comparison of Bupivacaine Instillation and Ultrasound Guided Field Block for Post-Operative Pain Relief in Inguinal Hernia Repair

Author: Iyad Abbas Salman* , Ali Moayed Jwad
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2017 Volume: 16 Issue: 3 Pages: 248-251
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND: Postoperative pain is a common problem after inguinal hernia repair. Postoperative pain may delay the return to normal activity and delay hospital discharge. Various techniques have been employed to provide postoperative analgesia, by the use of regional anesthetic technique, local anesthesia or traditional analgesic technique: opiates, non-steroidal anti-inflammatory drugs (NSAIDs) or combinations.OBJECTIVE: To compare the postoperative pain relief provided by simple bupivacaine wound instillation and ultrasound guided inguinal hernia field block.PATIENT AND METHOD: A single blind, prospective, randomized controlled clinical trial for 72 male patients who were undergoing elective unilateral inguinal hernia repair. In 37 of them 10 ml of 0.5% plain bupivacaine was instilled (irrigated) into the wound by the surgeon for 1 minute. In another 35 patients, ultrasound guided field block performed using 20 ml of 0.25% plain bupivacaine at the end of surgery. Vital signs, numerical pain score and analgesia requirement were recorded at recovery (zero hour), 1st, 2nd, 4th& 8th hours postoperatively.RESULT: By applying null hypothesis, using the t-student test of two independent samples, pain score and request for analgesia show significant difference only at the first two hours with p-value <0.05, otherwise there was no significant differences in the following hours. For vital signs there was no significant difference for both groupsCONCLUSION: Bupivacaine instillation is as effective as ultrasound guided field block for inguinal hernia repair pain. We recommend this technique in places where ultrasound machine is not available especially in many developing countries.

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