Devyani Pendharkar, Sabina Khan, S. Hameed, Shubham Vatsya
Heterotopic gastric mucosa of the proximal esophagus (HGMPE) also referred to as inlet patch is a salmon-colored patch located just distal to the upper esophageal sphincter. HGMPE is usually asymptomatic detected incidentally during endoscopy. Its clinical significance is mainly acid-related or neoplastic complications. Here, we present a case of a 58-year female presenting in the casualty with two episodes of upper gastrointestinal (UGI) bleeding. UGI Endoscopy revealed a large esophageal ulcer 1.5 cm × 1 cm just below the upper esophageal sphincter (UES). Biopsy from this area revealed a diagnosis of HGMPE. UGI bleed occurring as a complication of inlet patch has been very rarely reported. Only one case in literature is present making this case report the second one. This case highlights the importance of careful endoscopic evaluation of the UES region along with biopsy which may reveal heterotopic gastric mucosa in patients with unexplained UGI bleed.
食管近端异位胃黏膜(HGMPE)也称为入口贴片，是位于食管上括约肌远端的鲑鱼色贴片。HGMPE通常是在内镜检查中偶然发现的无症状。其临床意义主要是酸相关或肿瘤并发症。在这里，我们提出了一个58岁的女性在伤亡者提出了两个发作的上消化道(UGI)出血。UGI内窥镜显示食管上括约肌(UES)正下方1.5 cm × 1 cm的大食管溃疡。该区域活检诊断为HGMPE。UGI出血作为进气道贴片并发症的报道非常少。文献中仅有一例，使本病例成为第二例。本病例强调了在不明原因UGI出血患者中，内镜下对UES区域进行仔细评估以及活检的重要性，这可能会发现胃粘膜异位。
{"title":"Heterotopic gastric mucosa in the proximal esophagus manifesting as upper gastrointestinal bleeding: An uncommon presentation","authors":"Devyani Pendharkar, Sabina Khan, S. Hameed, Shubham Vatsya","doi":"10.4103/ssj.ssj_67_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_67_21","url":null,"abstract":"Heterotopic gastric mucosa of the proximal esophagus (HGMPE) also referred to as inlet patch is a salmon-colored patch located just distal to the upper esophageal sphincter. HGMPE is usually asymptomatic detected incidentally during endoscopy. Its clinical significance is mainly acid-related or neoplastic complications. Here, we present a case of a 58-year female presenting in the casualty with two episodes of upper gastrointestinal (UGI) bleeding. UGI Endoscopy revealed a large esophageal ulcer 1.5 cm × 1 cm just below the upper esophageal sphincter (UES). Biopsy from this area revealed a diagnosis of HGMPE. UGI bleed occurring as a complication of inlet patch has been very rarely reported. Only one case in literature is present making this case report the second one. This case highlights the importance of careful endoscopic evaluation of the UES region along with biopsy which may reveal heterotopic gastric mucosa in patients with unexplained UGI bleed.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115666494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fawaz M. Aldhafiri, F. Aldhafiri, M. Alshahrani, Adel Almaymuni, Mohammed Algethami, A. Maghrabi, Hisham A Rizk, Wisam H. Jamal
Background: Acute appendicitis is still known as one of the most common abdominal emergencies, one of the challenges encountered by the emergency physician is accurate diagnosis of acute appendicitis. In a trial to overcome these difficulties, this study aimed to assess the diagnostic accuracy of readily available and inexpensive inflammatory markers serum C-reactive protein (CRP) levels, white blood cells (WBCs), and neutrophils count in the diagnosis of acute appendicitis. Methods: This is a retrospective study. Two hundred and forty-one participants who performed appendectomy in King Abdulaziz University Hospital from January 1, 2013, to December 31, 2017, were included in this study, of which 148 (61.4%) were males and 93 (38.6%) were females. Chi-square and t-test were used for statistical analysis. Results: The study included 241 patients; the median CRP, WBCs, and neutrophils were significantly higher in patients who underwent open surgery and in complicated appendicitis compared to noncomplicated ones. Receiver operating characteristic curve analysis revealed higher accuracy of CRP in discrimination of acute appendicitis with a sensitivity and specificity of 94% and 57%, respectively. Conclusion: The diagnostic accuracy of the CRP is greater than the WBCs and neutrophil count. Thus, high serum CRP levels support the surgeon's clinical diagnosis. However, none of the studied markers is 100% diagnostic for acute appendicitis. It is recommended to include CRP measurement as a routine laboratory test in patients with suspected diagnosis of acute appendicitis.
{"title":"Correlation of serum C-reactive protein, white blood count, and neutrophil percentage with histopathological findings in acute appendicitis","authors":"Fawaz M. Aldhafiri, F. Aldhafiri, M. Alshahrani, Adel Almaymuni, Mohammed Algethami, A. Maghrabi, Hisham A Rizk, Wisam H. Jamal","doi":"10.4103/ssj.ssj_43_19","DOIUrl":"https://doi.org/10.4103/ssj.ssj_43_19","url":null,"abstract":"Background: Acute appendicitis is still known as one of the most common abdominal emergencies, one of the challenges encountered by the emergency physician is accurate diagnosis of acute appendicitis. In a trial to overcome these difficulties, this study aimed to assess the diagnostic accuracy of readily available and inexpensive inflammatory markers serum C-reactive protein (CRP) levels, white blood cells (WBCs), and neutrophils count in the diagnosis of acute appendicitis. Methods: This is a retrospective study. Two hundred and forty-one participants who performed appendectomy in King Abdulaziz University Hospital from January 1, 2013, to December 31, 2017, were included in this study, of which 148 (61.4%) were males and 93 (38.6%) were females. Chi-square and t-test were used for statistical analysis. Results: The study included 241 patients; the median CRP, WBCs, and neutrophils were significantly higher in patients who underwent open surgery and in complicated appendicitis compared to noncomplicated ones. Receiver operating characteristic curve analysis revealed higher accuracy of CRP in discrimination of acute appendicitis with a sensitivity and specificity of 94% and 57%, respectively. Conclusion: The diagnostic accuracy of the CRP is greater than the WBCs and neutrophil count. Thus, high serum CRP levels support the surgeon's clinical diagnosis. However, none of the studied markers is 100% diagnostic for acute appendicitis. It is recommended to include CRP measurement as a routine laboratory test in patients with suspected diagnosis of acute appendicitis.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121731521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The bedside and intraoperative ultrasound are used frequently in infants and children by the treating surgeon as a part of physical examination. The fundamentals of ultrasound physics are essential for proper image interpretation and understanding common ultrasound artifacts. We aimed to cover the basic physics terminologies, ultrasound components, modes, and tissue echogenicity in this review article.
{"title":"Physics behind ultrasound; what should I know as a pediatric surgeon?","authors":"O. Bawazeer, O. Bawazir","doi":"10.4103/ssj.ssj_70_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_70_21","url":null,"abstract":"The bedside and intraoperative ultrasound are used frequently in infants and children by the treating surgeon as a part of physical examination. The fundamentals of ultrasound physics are essential for proper image interpretation and understanding common ultrasound artifacts. We aimed to cover the basic physics terminologies, ultrasound components, modes, and tissue echogenicity in this review article.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126219664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Mandal, Ipsita Aggarwal, Shouvik Das, Anmol Galhotra, S. Marwah
Background: The surgical site infections (SSIs) are the most common cause of nosocomial infection in surgical patients and are associated with high morbidity, considerable mortality, longer hospital stay, and increased health-care costs. Evidence suggests that incisional negative pressure wound therapy (INPWT) can decrease wound complications, but there is scanty literature regarding INPWT for high-risk laparotomy incisions. Materials and Methods: A prospective interventional randomized study was conducted over a period of 2 years from May 1, 2018, to April 30, 2020. The enrolled patients were randomized to the study group where INPWT was applied and the control group where patients were subjected to conventional wound dressings. Results: Out of 85 patients undergoing emergency laparotomy, 36 patients were allocated to the study group and 38 patients to the control group after meeting the exclusion criteria. Baseline demographic characteristics were similar in both the groups. The relative risk (95% confidence interval) of SSI, burst abdomen, and rehospitalization was significantly more in the control group (study versus control group): 0.65 versus 1.4, 0.67 versus 1.33, and 0 versus 2.03, respectively. Conclusions: Prophylactic use of NPWT is a safe and effective method for preventing SSI and other wound complications in emergency laparotomy for peritonitis, which is a major deciding factor in final wound outcome in such cases.
{"title":"Low-cost prophylactic negative pressure wound therapy using central suction device in preventing surgical site infections in patients undergoing emergency laparotomy","authors":"A. Mandal, Ipsita Aggarwal, Shouvik Das, Anmol Galhotra, S. Marwah","doi":"10.4103/ssj.ssj_72_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_72_21","url":null,"abstract":"Background: The surgical site infections (SSIs) are the most common cause of nosocomial infection in surgical patients and are associated with high morbidity, considerable mortality, longer hospital stay, and increased health-care costs. Evidence suggests that incisional negative pressure wound therapy (INPWT) can decrease wound complications, but there is scanty literature regarding INPWT for high-risk laparotomy incisions. Materials and Methods: A prospective interventional randomized study was conducted over a period of 2 years from May 1, 2018, to April 30, 2020. The enrolled patients were randomized to the study group where INPWT was applied and the control group where patients were subjected to conventional wound dressings. Results: Out of 85 patients undergoing emergency laparotomy, 36 patients were allocated to the study group and 38 patients to the control group after meeting the exclusion criteria. Baseline demographic characteristics were similar in both the groups. The relative risk (95% confidence interval) of SSI, burst abdomen, and rehospitalization was significantly more in the control group (study versus control group): 0.65 versus 1.4, 0.67 versus 1.33, and 0 versus 2.03, respectively. Conclusions: Prophylactic use of NPWT is a safe and effective method for preventing SSI and other wound complications in emergency laparotomy for peritonitis, which is a major deciding factor in final wound outcome in such cases.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131448280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdullah O. Bawazir, A. Mahomed, N. Kausar, Razan Bawazir, Rayan Halabi, I. Mamoun, Mohammed Maimani
Congenital liver cyst is an uncommon disease in infancy and is usually asymptomatic. However, even rarer are congenital giant liver cysts which by virtue of their size are problematic. We discuss a case of a newborn with a giant hepatic cyst who was successfully treated surgically but experienced a postoperative bile leak as a complication. We review the management of this entity and propose an algorithm of care.
{"title":"Management of congenital giant liver cyst with postoperative bile leak: A case report and literature review","authors":"Abdullah O. Bawazir, A. Mahomed, N. Kausar, Razan Bawazir, Rayan Halabi, I. Mamoun, Mohammed Maimani","doi":"10.4103/ssj.ssj_65_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_65_21","url":null,"abstract":"Congenital liver cyst is an uncommon disease in infancy and is usually asymptomatic. However, even rarer are congenital giant liver cysts which by virtue of their size are problematic. We discuss a case of a newborn with a giant hepatic cyst who was successfully treated surgically but experienced a postoperative bile leak as a complication. We review the management of this entity and propose an algorithm of care.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127202869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Omar Al-Komi, Anas Alnajjar, M. Khalifa, A. Al-Khani, Osman H Basheir
Background: Bariatric surgeries form an integral part of morbid obesity management. In addition, alopecia is steadily being reported as a postoperative event. Alopecia is related to the nutritional deficiency occurring due to bariatric surgery, postoperative rapid weight loss, and major surgery-related stress. This review aims to evaluate rates of zinc deficiency as a postoperative complication of bariatric surgery and its association with alopecia. Methodology: A PubMed literature search conducted between February 6, 2020 and April 3, 2020, from which 32 studies were identified that reported zinc status and hair loss following bariatric surgery. Results: Most of the articles, 14 (48.28%) articles, 7 (24.14%) articles, reported prospective cohort and retrospective cohort studies, respectively. Moreover, 16 (55.17%) publications were about Roux-en-Y gastric bypass (RYGB) surgery, while sleeve gastrectomy was conducted in 9 (31.03%) studies. Rates of zinc deficiency were reported in 93.10% of the studies. Five studies (17.24%) included the rates of alopecia and most of them revealed female predominance. Decreased food intake was considered as a common cause of zinc deficiency after gastrectomy; on the other hand, decreased zinc absorption was a factor in RYGB patients. Conclusion: Bariatric surgery is an effective measure in managing morbid obesity and its complications. However, it could be associated by zinc deficiency and consequent alopecia, particularly in females. A meta-analysis is needed to assess this correlation more thoroughly and to determine the potential value of regularly giving micronutrient supplements to prevent such a complication.
{"title":"Alopecia and zinc deficiency in postbariatric surgery patients","authors":"Omar Al-Komi, Anas Alnajjar, M. Khalifa, A. Al-Khani, Osman H Basheir","doi":"10.4103/ssj.ssj_60_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_60_21","url":null,"abstract":"Background: Bariatric surgeries form an integral part of morbid obesity management. In addition, alopecia is steadily being reported as a postoperative event. Alopecia is related to the nutritional deficiency occurring due to bariatric surgery, postoperative rapid weight loss, and major surgery-related stress. This review aims to evaluate rates of zinc deficiency as a postoperative complication of bariatric surgery and its association with alopecia. Methodology: A PubMed literature search conducted between February 6, 2020 and April 3, 2020, from which 32 studies were identified that reported zinc status and hair loss following bariatric surgery. Results: Most of the articles, 14 (48.28%) articles, 7 (24.14%) articles, reported prospective cohort and retrospective cohort studies, respectively. Moreover, 16 (55.17%) publications were about Roux-en-Y gastric bypass (RYGB) surgery, while sleeve gastrectomy was conducted in 9 (31.03%) studies. Rates of zinc deficiency were reported in 93.10% of the studies. Five studies (17.24%) included the rates of alopecia and most of them revealed female predominance. Decreased food intake was considered as a common cause of zinc deficiency after gastrectomy; on the other hand, decreased zinc absorption was a factor in RYGB patients. Conclusion: Bariatric surgery is an effective measure in managing morbid obesity and its complications. However, it could be associated by zinc deficiency and consequent alopecia, particularly in females. A meta-analysis is needed to assess this correlation more thoroughly and to determine the potential value of regularly giving micronutrient supplements to prevent such a complication.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134547621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Colostomy closure is an operation frequently performed in surgical practice, despite its benefits, it can produce significant morbidity and mortality. We have focused on the complications related to this surgery in regard to the closure technique and the optimal time for stoma closure and on the proper wound management in the postoperative period. Patients and Methods: Ninety-six patients were male between 17 and 53 years (median 35), they have been subjected to colostomy closure surgery in single-layer (52 cases) and double-layer (44 cases) closure techniques according to the surgeon preference. The interval time for colostomy closure was more than 3 months in 56 cases, while the interval time was <3 months in 40 cases, and a primary wound closure for 87 cases and delayed (after few days) wound closure for 9 cases. The colostomies were created following penetrating abdominal trauma at Al-Yarmouk Teaching Hospital in a period between October 2003 and October 2007. Results: The total number of complications was 26 (27.08%), as fecal fistula 10 cases and wound infection 16 cases. Colostomy closure more than 3 months interval had 12.5% postoperative complications versus 47.5% if <3 months interval. Regarding single-layer anastomosis, 3.84% developed fecal fistula and (11.53%) developed wound infection versus 18.18% and 22.72%, respectively, in double-layer anastomosis group. No case developed wound infection with delayed wound closure versus 16 cases (18.39%) in primary wound closure. Discussion: The incidence of complications was more in double-layer (continuous) technique of closure colostomy versus single layer. While if the interval time for stoma closure is 3 months and more, it would give good results. Regarding wound management, delayed primary wound closure resulted in a better wound healing than the conventional skin closure technique. Conclusion: Based on this experience, we believe that colostomy closure can be performed with minimal morbidity and would result in a successful surgical outcome. Providing a meticulous technique used by a single layer (continuous seromuscular sutures plus stay sutures) anastomosis, more than three months interval time and a delayed wound closure the outcome will be much better.
{"title":"Technique, timing, and wound management of closure colostomy","authors":"Aamer Kamil, Raafat Al-Turfi, Sinan Hamid","doi":"10.4103/ssj.ssj_61_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_61_21","url":null,"abstract":"Introduction: Colostomy closure is an operation frequently performed in surgical practice, despite its benefits, it can produce significant morbidity and mortality. We have focused on the complications related to this surgery in regard to the closure technique and the optimal time for stoma closure and on the proper wound management in the postoperative period. Patients and Methods: Ninety-six patients were male between 17 and 53 years (median 35), they have been subjected to colostomy closure surgery in single-layer (52 cases) and double-layer (44 cases) closure techniques according to the surgeon preference. The interval time for colostomy closure was more than 3 months in 56 cases, while the interval time was <3 months in 40 cases, and a primary wound closure for 87 cases and delayed (after few days) wound closure for 9 cases. The colostomies were created following penetrating abdominal trauma at Al-Yarmouk Teaching Hospital in a period between October 2003 and October 2007. Results: The total number of complications was 26 (27.08%), as fecal fistula 10 cases and wound infection 16 cases. Colostomy closure more than 3 months interval had 12.5% postoperative complications versus 47.5% if <3 months interval. Regarding single-layer anastomosis, 3.84% developed fecal fistula and (11.53%) developed wound infection versus 18.18% and 22.72%, respectively, in double-layer anastomosis group. No case developed wound infection with delayed wound closure versus 16 cases (18.39%) in primary wound closure. Discussion: The incidence of complications was more in double-layer (continuous) technique of closure colostomy versus single layer. While if the interval time for stoma closure is 3 months and more, it would give good results. Regarding wound management, delayed primary wound closure resulted in a better wound healing than the conventional skin closure technique. Conclusion: Based on this experience, we believe that colostomy closure can be performed with minimal morbidity and would result in a successful surgical outcome. Providing a meticulous technique used by a single layer (continuous seromuscular sutures plus stay sutures) anastomosis, more than three months interval time and a delayed wound closure the outcome will be much better.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124645431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Bamnodkar, Ramesh Dumbre, Arun Fernandese, Deepak S. Phalgune
Background: Controversies persist regarding excision of ilioinguinal nerve after inguinal hernia repair and the procedure is not widely accepted. The present study was aimed to compare outcomes and its impact on the quality of life between routine ilioinguinal nerve excision, and nerve preservation following Lichtenstein inguinal hernia repair. Materials and Methods: Eighty-six patients scheduled for Lichtenstein inguinal hernia repair were randomly divided into two equal groups of 43 patients each. Group A patients underwent prophylactic neurectomy, whereas, in Group B patients, the nerve was preserved. Follow-up was done on day one, 3 months, 6 months, and 9 months after surgery. The primary outcome measure was the incidence of chronic groin pain, whereas secondary outcome measures were an impact on the quality of life and time to return to work. Inter-group comparison of categorical and continuous variables was done using Fisher's exact test and unpaired t-test respectively. Results: The incidence of postoperative pain at 3 months was 13/43 (30.2%) and 5/43 (11.6%) in Group B and Group A, respectively (P = 0.034). The incidence of postoperative pain at 6 months was 11/43 (25.6%) and 3/43 (7.0%) in Group B and Group A, respectively (P = 0.038). The RAND 36-Item Short-Form Health Survey parameters such as mean social functioning scores at 6 months postoperatively were 88.4 and 82.9 in Group A as Group B, respectively (P = 0.037) and mean pain score was 98.7 and 95.3 in Group A as Group B, respectively (P = 0.047). The mean time to return to work was 4.5 days and 5.7 days in Group A as Group B, respectively (P = 0.002). Conclusion: A routine ilioinguinal neurectomy is a reasonable option for preventing neuralgia when performing Lichtenstein inguinal hernia repair.
{"title":"Prophylactic ilio-inguinal neurectomy in open inguinal hernia repair: A randomized controlled study","authors":"P. Bamnodkar, Ramesh Dumbre, Arun Fernandese, Deepak S. Phalgune","doi":"10.4103/ssj.ssj_59_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_59_21","url":null,"abstract":"Background: Controversies persist regarding excision of ilioinguinal nerve after inguinal hernia repair and the procedure is not widely accepted. The present study was aimed to compare outcomes and its impact on the quality of life between routine ilioinguinal nerve excision, and nerve preservation following Lichtenstein inguinal hernia repair. Materials and Methods: Eighty-six patients scheduled for Lichtenstein inguinal hernia repair were randomly divided into two equal groups of 43 patients each. Group A patients underwent prophylactic neurectomy, whereas, in Group B patients, the nerve was preserved. Follow-up was done on day one, 3 months, 6 months, and 9 months after surgery. The primary outcome measure was the incidence of chronic groin pain, whereas secondary outcome measures were an impact on the quality of life and time to return to work. Inter-group comparison of categorical and continuous variables was done using Fisher's exact test and unpaired t-test respectively. Results: The incidence of postoperative pain at 3 months was 13/43 (30.2%) and 5/43 (11.6%) in Group B and Group A, respectively (P = 0.034). The incidence of postoperative pain at 6 months was 11/43 (25.6%) and 3/43 (7.0%) in Group B and Group A, respectively (P = 0.038). The RAND 36-Item Short-Form Health Survey parameters such as mean social functioning scores at 6 months postoperatively were 88.4 and 82.9 in Group A as Group B, respectively (P = 0.037) and mean pain score was 98.7 and 95.3 in Group A as Group B, respectively (P = 0.047). The mean time to return to work was 4.5 days and 5.7 days in Group A as Group B, respectively (P = 0.002). Conclusion: A routine ilioinguinal neurectomy is a reasonable option for preventing neuralgia when performing Lichtenstein inguinal hernia repair.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131050801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A long-standing and large-sized hepatic hydatid cyst located at the liver hilum is likely to rupture into the adjoining major bile ducts. This unusual complication demands preoperative diagnosis at an early stage and adequate surgical management so as to prevent morbidity and mortality. Such cases are managed with bilioenteric anastomosis by doing Roux-en-Y cystojejunostomy. However, one such case was managed by performing side to side anastomosis between disrupted hydatid cyst at the hilum and adjoining gallbladder. This innovative surgical procedure was named “Cysto-cholecystostomy” and was reported for the first time in the English literature. This case report presents ten years of follow up of this patient along with discussion of related cases published in the literature.
{"title":"Cystocholecystostomy: A new technique for management of hilar biliary disruption due to a large hydatid cyst liver - Ten years of follow-up","authors":"S. Marwah, Rambeer Singh, A. Mandal, Shouvik Das","doi":"10.4103/ssj.ssj_73_21","DOIUrl":"https://doi.org/10.4103/ssj.ssj_73_21","url":null,"abstract":"A long-standing and large-sized hepatic hydatid cyst located at the liver hilum is likely to rupture into the adjoining major bile ducts. This unusual complication demands preoperative diagnosis at an early stage and adequate surgical management so as to prevent morbidity and mortality. Such cases are managed with bilioenteric anastomosis by doing Roux-en-Y cystojejunostomy. However, one such case was managed by performing side to side anastomosis between disrupted hydatid cyst at the hilum and adjoining gallbladder. This innovative surgical procedure was named “Cysto-cholecystostomy” and was reported for the first time in the English literature. This case report presents ten years of follow up of this patient along with discussion of related cases published in the literature.","PeriodicalId":420307,"journal":{"name":"Saudi Surgical Journal","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126048099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahmed Almumtin, Hassan A Alsaleem, Zahara Al-Ali, Sarah A Alsadah, Ala Alshareef, S. Alshammasi
Importance: Despite the improvement of treatment modalities and technical aspects, recurrence following hernia repair remains one of the main problems for the surgical community. More specifically, previous Cochrane Systematic Review and large database studies compared Lichtenstein repairs. However, none of the relevant published reports were representative of the Saudi population. Objective: This study's objective was to investigate the overall and gender-specific prevalence of recurrences in patients who had undergone Lichtenstein mesh repair of primary inguinal hernia (IH) in the KFHU Centre. Design: This is a retrospective record review study conducted between January 2000 and December 2014. Setting: The study was conducted at a single center located in Saudi Arabia, at King Fahed Hospital University KFHU center. Participants: Adults (≥18 years of age), with IH, operated at KFHU using standard Lichtenstein open mesh repair, and had minimum follow-up of 2 years were included in the study. Laparoscopically operated cases, recurrent and emergently operated cases were excluded from the study. Main Outcome (s) and Measure (s): Data were collected by records review and included sociodemographic characteristics (age, gender, and family history), hernia type and location, risk factors (body mass index [BMI], smoking, comorbidities, etc.), recurrence and other complications (pain, wound hematoma and seroma, infection, etc.). Results: We report a recurrence rate of 1.3% following Liechtenstein mesh repair at our center. As for patient-related factors that were found to be significantly associated with the recurrence of an IH were older age, higher BMI, the existence of hypertension, chronic cough and diabetes, in addition to smoking and lifting heavy objects. Conclusion: We have identified several likely factors associated with higher recurrence after hernia repair. A comparison of the rates of recurrence and complications between different procedures should, therefore, be an important topic to address in future studies.
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