Introduction: The Morgagni hernia is one of the rarest hernias. With the overall incidence rate of 3% of all the diaphragmatic hernias. Laparoscopic repair has proved to be successful in the repair of this hernia. The minimal access surgery entails the benefits of the early ambulation and less necessity of analgesia with early postoperative recovery. The defect closure can be done with primary closure or using the prosthetic mesh which may be composite or polypropylene. The recurrence rate is not yet exactly known in cases of primary repair. Some studies favor the use of prosthetic mesh in all the cases of diaphragmatic mesh repair. Case Presentation: A 75 year old lady presented with complaints of abdominal pain for 4 to 5 months and vomiting for 1 month. With a history of intermittent fever. Physical examination revealed tenderness in the epigastrium, so she was considered the indication for the laparoscopic diaphragmatic hernia repair with prosthetic composite mesh placement. Conclusions:The Morgagni hernia repair with minimal access surgery may be a boon in the surgical field. This is a rare case of hernia in both the Morgagni's and Larrey's space. Which demonstrates all the benefits of minimal access surgery. Further randomized control trials may be needed to prove the exact advantages of minimal access surgery vs open surgery.
BACKGROUND Fistula-in-ano or anal fistulas are documented since ancient times and their management has always been a challenge. Various modalities of treatment are available and newer ones are being added each day. The aim of this retrospective study is to analyse the outcome of the video assisted anal fistula treatment (VAAFT), one of the modalities of treatment for complex anal fistulas done at our centre. METHODS Records of patients who had been treated through VAAFT by single senior consultant surgeon of Minimal Access Surgery unit between April 2013 and March 2019, were collected and analysed. RESULTS Altogether, records of 48 (forty-eight) patients who had undergone VAAFT during the period were analysed. Data revealed that 38 male (79.17 %) and 10 female (20.83 %) patients with mean age of 49.96 ± 12.22 years were operated. Most commonly, trans sphincteric followed by inter sphincteric type of fistulae were encountered. In 3 cases, internal opening couldn’t be visualised. Six patients were documented to have a recurrence within 6 months of the procedure and in the rest were cured except in a small subset of patients who did not follow up. CONCLUSIONS Amongst the wide range of armamentarium available today for the treatment of complex anal fistulas, video assisted anal fistula treatment (VAAFT) is a novel sphincter saving technique. The recurrence rate at our centre was at par with other studies and with zero incontinence rate, however further RCTs are required. KEYWORDS Complex Anal Fistula, Fistula-in-Ano, MEINERO Fistuloscope, VAAFT
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