Objective:
The objective is to study the role of antibiotic prophylaxis, if any, in the prevention of wound infection after open mesh repair of primary inguinal hernias.
Materials and Methods:
Patients coming to outpatient department for open mesh repair of inguinal hernia were randomized into the placebo group and antibiotic group, a total of 150 patients were enrolled in the study. Follow-up was done up to 1 month to look for any evidence of surgical site infection using the criteria of Centers for Disease Control on wound infection.
Results:
Twelve patients in the antibiotic group and nine patients in the placebo group were found to have evidence of surgical site infection. This difference was found to be insignificant with
P
= 0.14. Three patients in the placebo group developed deep surgical site infection but on analysis, this difference was also found to be insignificant with
P
= 0.122.None of these patients required mesh removal.
Conclusion:
The result of the present study suggests that the use of prophylactic antibiotics during mesh repair of primary inguinal hernias does not give any extra protection from infections. Multicenter meta-analysis is required to give definite guidelines regarding the use of prophylactic antibiotics.
Unusual clinical course Background: Intussusception is not very common in adults, and acute intestinal obstruction with intussusception due to inflammatory myofibroblastic tumor (IMT) is extremely rare. IMT is an uncommon lesion and has no single defined cause. It predominantly affects the pediatric age group and commonly involves the lungs. Here we present a case of IMT causing ileocolic intussusception leading to acute intestinal obstruction in an adult. Case Report: A 40-year-old female came to the emergency department with severe colicky pain in her abdomen, and reported 6 to 7 episodes of vomiting with bilious contents, along with an inability to pass feces and flatus for 3 days. An x-ray of her abdomen in erect posture revealed multiple air-fluid levels. Because she had a previous history of tuberculosis, a possible tubercular stricture as the cause of her acute obstruction was considered; an exploratory laparotomy was performed showing her bowel loops were dilated with ileocolic intussusception. The lead point of intussusception (a well-defined 4×4×3.5 cm solid mass), was found at 15 cm proximal to the ileocecal junction. A right hemicolectomy with ileo-transverse anastomosis was performed. The histopathological examination confirmed the presence of IMT. Conclusions: IMT causing ileocolic intussusception with acute intestinal obstruction is an extremely rare presentation of an uncommon entity in adults. High index of suspicion, and appropriate investigations (x-ray abdomen, ultrasound, computed tomography, and colonoscopy) depending on presentation and clinical condition of the patient can result in prompt diagnosis and early management.
Spontaneous gastric perforations are usually seen in patients with untreated peptic ulcer disease. Mucormycosis, an uncommon, opportunistic, life-threatening fungal infection, rarely causes gastric perforation in immunocompetent adults. Here, we present a case of young female who was admitted to hospital for acute pain abdomen and distension with 5 days history of fever. She was operated and was found to have multiple perforations in the stomach with transmural necrosis. Despite adequate surgical excision and intravenous amphotericin B, patient succumbed to sequelae of infection.
Background: Complicated inguinal hernia is a common problem faced by surgeons across the world. Various methods of surgical repair have been described. It is important to identify the best repair technique of inguinal hernia to have better post-operative outcome.Methods: This randomised controlled study consisted of 84 cases of complicated inguinal hernias presenting to surgical emergency department of Maulana Azad Medical College. Patients were randomly allocated to two repair groups- Desarda and Bassini and various intra/post-operative parameters were compared.Results: Duration of surgery and postoperative pain scores were less in Desarda group. Time to return to strenuous daily activities was also less with Desarda repair. Desarda repair was associated with less incidence of chronic inguinodynia and post-operative complications.Conclusions: Desarda repair was found to be superior to Bassini group due to shorter duration of surgery. Patients required less analgesics following Desarda repair as compared to Bassini group. There was no recurrence in any group at four months follow up.
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