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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
General Assessment For Predisposing Factors Of

Author: Munthir Al-Obaidi F.R.C.S د. منذر العبيدي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2007 Volume: 49 Issue: 2 Pages: 181-185
Publisher: Baghdad University جامعة بغداد

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Abstract

Summary:Background:Incisional hernia is frequently occurring post operative complication after general surgery with occurance rate 2%-----11%,, it is either appear soon after operation or late occurring incisional hernia..Patient &methods: This is a prospective study that was conducted on 84 patients who were admitted at Baghdad Teaching Hospital during the period from Oct. 1999 to Aug. 2001 for repair of incisional hernias. Their ages were ranging from 24-74 years with mean age of (48 ±12). Sixty-nine patients were elective and 15 patients were urgent. Assessment of the patients for the predisposing factors influencing the development of incisional hernia was done and in our study these factors were: -Results:.Wound infection in 66%, midline incision in 58.3%, obesity 55%, chronic obstructive pulmonary disease (COPD), with, respiratory tract infection (RTI) in 44%, multiparty with gynecological and obstetric procedures were 42.9%, diabetes mellitus (D.M) 28.9%, Old age in 21.4%, contaminated bowel surgery 21.4% & finally wound dehiscence with re-suturing in 7.1%. Simple repair was performed in 57 patients and prolene mesh repair was used for 27 patients and follow-up was continued for 6 months except for 8 patients who were lost from follow-up. Results of simple repair was associated with many complications including recurrence in 4 patients, wound infection in 10 patients, seroma in 3 patients deep venous thrombosis (DVT) in one patient.Whereas Mesh repair was followed with minimal complications of seroma in 3 patients and deep venous thrombosis (DVT) in one patient and no recurrence was recorded.Conclusion: wound infection,,obesity,emergency surgery ,type of suture material & type of wound all areimportant factors leading to I.H. Key word: incisional hernia causes,,simple or mesh repair.__________________________________________________________________________________________


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
Evaluation of Sublay Mesh Repair in Comparison with Onlay Mesh Repair for Incisional Hernias

Author: Haider Abdulhussein Ahmed
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 2 Pages: 180-184
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND: Incisional hernia after abdominal surgery is a well-known complication and the incidence of incisional hernias continues to be 2-11% after laparotomy. The repair of incisional hernia has always been a challenge to the surgeon. Various operative techniques for the repair of incisional hernia are in practice; however, the management is not standardized. The sublay technique, popularized by Rives and Stoppa in Europe, has been reported to be quite effective, with low recurrence rates and minimal complications.OBJECTIVE: To study the advantage and complications of sublay mesh repair of incisional hernias in comparison to onlay mesh repair.METHODS: Record of 110 patients undergoing repair of incisional hernia from 1st Jun 2013 to 1st Jun 2015, excluding very large incisional hernia with defect more than 10 cm. 62 cases of incisional hernias were managed by onlay mesh repair and 48 cases of incisional hernia were managed by sublay mesh repair.RESULTS: Post-operative complications like seroma and wound infection were comparable in both groups. In sublay group, Seroma formation was 2 patients (4.3%) . wound infection was 2 patients (4.3%). No septic mesh was removed in the series. In onlay group seroma formation was in 12 patients (19.4%) most of seroma occur in large incisional hernias repair, wound infection was in 5 patients (8.1%) and 2 septic mesh was removed. In sublay, recurrence rate was one patient (2.1%), in onlay, recurrence rate was in 5 patients (8%). CONCLUSION: Sublay mesh although it is more time consuming and technically more difficult, however it carries low recurrence rate and few post-operative wound complication ..


Article
Open Mesh versus Non-Mesh Repair of Inguinal Hernia
مقارنة أصلاح الفتق المغبني بالشبكة أو بدون الشبكة

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AbstractBackground; The repair of inguinal hernia carries considerable risk of recurrence in spite of the large number of studies there is no agreement on best surgical technique.Objective: To compare the outcome of inguinal hernia repair using mesh, and non mesh technique and to find the most suitable method of repairing.Patients and Methods; A study of 76 patients used to evaluate open inguinal hernia repair divided into 2 groups treated by mesh and non mesh technique during the period from April2005-October2009. Results; 76 patients divided into 2 groups, Group A; Forty patients treated by mesh repair, 95% males, 5% females, mean age 46 years. Indirect hernia 85% of the patients, 12.5% direct hernia, and 2.5%sliding hernia, postoperative complications; seroma(2.5%),superficial wound infection(5%),deep infection(7.5%),urinary retention(2.5%), scrotal swelling(5%),pain more than 3 days(5%),no testicular atrophy and recurrence. Group B; 36 patients treated by non mesh repair, 86% males, 14% females, mean age 50 years. Indirect hernia 83.35%, 11.15% direct hernias, and 5.5% sliding hernia, postoperative complications; seroma (5.5%), superficial wound infection (11%), deep infection (2.7%), urinary retention (5.5%),scrotal swelling(11%), pain more than 3 days(13.8%),testicular atrophy(2.7%),and recurrence(2.7%).Conclusion; the mesh repair was found to be superior to the non mesh in treating inguinal hernia.Keywords: Inguinal hernia, open mesh, non mesh repair, complications.

الخلفية: أصلاح الفتق المغبني يحمل أعتبار خطر رجوع الفتق على الرغم من عدة دراسات لم يتفق على أفضل طريقة.الغرض: مقارنة نتائج أصلاح الفتق بالشبكة أو بدون الشبكة لأيجاد طريقة أسهل وأكثر ملائمة.الطرق والعلاج: دراسة 76 مريض لتقييم أصلاح الفتق بالشبكة أو بدون الشبكة للفترة من نيسان 2005 ولغاية تشرين الأول 2009 م.النتائج:76 مريض بصنفيينصنف أ: 40 مريض, رتق الفتق بالشبكة,95% ذكور,5% أناث,متوسط العمر 46 سنه فتق غير مباشر ,12.5% فتق مباشر ,2.5% فتق منزلق.المضاعفات 2.5% تجمع سوائل التهاب سطحي,5% التهاب عميق,7.5% احتباس البول,2.5% وجع أكثر من 3 أيام,5% وذمة كيس الصفن,لايوجد ضمور الخصية ولا رجوع الفتق.صنف ب : 36 مريض رتق الفتق بدون الشبكة, 86% ذكور,14% أناث, متوسط العمر 50 سنة,83.35% فتق غير مباشر,11.15% فتق مباشر,5.5% فتق منزلق.المضاعفات5.5%تجمع سوائل,11% التهاب سطحي,2,7% التهاب عميق,5.5%احتباس البول,13.8% وجع اكثر من 3 أيام,11% وذمة كيس الصفن,2.7% ضمور الخصية,2.7% رجوع الفتق.ألاستنتاج: طريقة رتق الفتق بالشبكة تفوق بدون الشبكة.مفتاح الكلمات: فتق مغبني,رتق بالشبكة , رتق بدون الشبكة, ألمضاعفات.


Article
Amyand’s hernia with healthy looking vermiform appendix, treatment of three cases with review of literatures
فتق " أمياند" المحتوي على زائده دوديه غير ملتهبه, علاج ثلاث حالات مع مراجعة البحوث السابقه

Author: Nabil I. Naiem نبيل عصام نعيم
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2018 Volume: 60 Issue: 3 Pages: 174-178
Publisher: Baghdad University جامعة بغداد

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Abstract

The term Amyand’s hernia refers to an incarcerated inguinal hernia containing the vermiform appendix,which may be completely healthy, inflamed or perforated. (1)Amyand’s hernia is named after Claudius Amyand, who on December, 6,1735 performed the 1stsuccessful appendectomy during the treatment of 11 years old boy presented with right inguinal hernia .During the surgery Amyand found a pin within the appendix which was encrusted with stone theappendix was found within the inguinal hernia sac. (2) It should not be confused with the incidentalfindings of cecal appendix within the femoral hernia sac “ de Garengeot’s hernia” which is firstdescribed by Rene de Garengeot in 1731(3.4)In almost 1% of all inguinal hernias Amyand’s hernia is detected and acute appendicitis in Amyand’shernia cases accounts only for 0.1% “ 0.07-0.13”. (5)The reported mortality rate of Amyand’s hernia ranges from 5.5%- 30%.This variation occurs due to the effect of early diagnosis, giving proper treatment, preventing intraabdominal sepsis, and good postoperative care. (6) It is generally accepted that surgical treatment ofAmyand’s hernia includes both appendectomy and hernia repair. (5,6.7)However, appendectomy in the absence of an inflamed appendix and the use of mesh in cases ofappendectomy remain to be controversial.Some authors offer not to perform prophylactic appendectomy when non inflamed appendix isincidentally found in the hernial sac. (6)Others believe that appendectomy should be performed in all cases to prevent future reherniation andappendicitis. (8.9) It has been thought that it is impossible to reach sufficient number of Amyand’shernias cases to get evidence- based data due to its rarity. Therefore it is logical to revise theclassification and surgical treatment of Amyand’s hernia based on the case reports from differentinstitutions. The aim of this study is to review the experience of mesh inguinal hernia repair withoutperforming appendectomy in patients with Amyand’s hernia with healthy looking vermiform appendixwith close postoperative follow up to detect recurrence or other postoperative complications.

فتق "أمياند" هو الفتق المغبني في حالة وجود الزائده الدوديه من ضمن محتوياته سواء كانت الزائده ملتهبه أو غير ملتهبه, وتحصل هذه الحاله بواقع 1من حالات الفتق المغبني.عرض الحالات:أجريت هذه الدراسه عبر مراجعة ) 402 ( حاله من عمليات الفتق المغبني أجريت في مستشفى الشهيد أحمد أسماعيل – السليمانيه - جمهورية العراقفي الفتره من أبريل 2013 الى أبريل 2018من جميع هذه الحالات وجدت فقط ) 3( حالات من فتق "أمياند" جميعها احتوت على زائده دوديه غير ملتهبه, تم اصلاح الفتق للحالات الثلاثه عن طريقوضع شبكة )البرولين( بدون أجراء عملية رفع الزائده الدوديه.ألأستنتاج:فتق "أمياند" هي حاله نادره تمثل تحديا من ناحية اتخاذ القرار المتعلق بطريقة العلاج لكونه يرتكز على عوامل متعدده.نجد انه من المهم ان تكون للجراح معلومات كافيه عن انواع هذا الفتق وطرقه العلاجيه المتعدده.

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