Introduction: There are several described techniques for ventral hernia mesh repair in both laparoscopic and open approach. Both approaches have their own pros and cons. Ventralex patch repair is an open technique using dual mesh in the intraperitoneal plane for ventral hernia repair. Aim: To describe an open technique with the use of ventalex patch in the repair of selected ventral hernias and to compare the open technique in terms of cost, operating time, complications and duration of hospital stay with the similar studies using Ventral patch and available literature for open and laparoscopic repair. Materials and Methods: This retrospective study was conducted on 248 patients over a period of seven years who underwent open ventral hernia repair with the Ventralex Patch, at a tertiary care hospital. A retrospective chart review and telephonic interview was conducted postoperatively and at the end of at least 24 months to assess for outcomes, particularly recurrence. Descriptive statistics reported using frequency and percentage for categorical variables. Continuous variables were reported using mean±Standard Deviation (SD). Results: A total of 248 patients underwent hernioplasty with ventralex patch. The mean age was 50.57 years and mean BMI was 28.37 kg/m2. The average duration of operation was 27.5 minutes and hospital stay was 2.275 days. The most common defect size was 2 cm (47.2%). The cost analysis of this technique revealed an average cost of INR 35,142 as opposed to an average cost of INR 88,601 for laparoscopic repair (including disposables) and INR 30,174 for open traditional sub-lay repair. Twenty-one patients developed surgical site infection (8.5%), and 27 patients (10.9%) developed seroma formation. A total of six patients developed superficial skin necrosis. The cumulative hernia recurrence rate at the end of 24 months was 6.5% (16/248). Conclusion: Ventralex patch repair is very efficient and effective in the treatment of selective umbilical, periumbilical, epigastric and incisional hernias with a comparable complication profile in terms of short term complications and recurrence rate compared to available literature.
A thirty-year-old lady presented with left lower abdominal pain radiating to the groin for one day. The pain was associated with a left groin swelling. On examination there was a 3 × 3 cm globular, nonfluctuant, tender and irreducible swelling in the left groin, with a positive cough impulse. Examination of the other hernial sites were normal. She underwent a diagnostic laparoscopy proceed left inguinal exploration and hernia repair. Intraoperatively there was left indirect inguinal hernia with the left ovary, fallopian tube and ectopic rudimentary horn of the uterus as contents. Her post-operative period in the ward was uneventful and she was discharged on the fourth post-operative day.
Background: Surgical referrals for lymph node biopsies are common, majority for diagnostic purposes. The indications and the diagnostic yield vary for different sites. We conducted an audit of the lymph node biopsies done over a period of seven months.Methods: The audit included 547 patients who underwent lymph node biopsies under local anesthesia in the department of general surgery over a seven-month period. Parameters such as overall diagnostic yield of lymph node biopsies, disease specific yield of lymph node biopsies with a primary focus on tuberculosis; site specific yield of lymph node biopsies and referral pattern for the request for lymph node biopsies were analysed.Results: 324 samples (59.2%) yielded a definite diagnosis, which included haematological malignancy 102 (31.5%), infectious diseases 131 (40.5%), and 59 (18.5%) malignancy. The diagnostic yield of supraclavicular lymph nodes was found to be highest (72.45%) and the axillary group the lowest (39.8%). The referral pattern seen was 314 (57.4%) from General medicine, 149 (27.2%) from General Surgery, and 84 (15.4%) from Haematology. 130 (23.8%) samples were tested for tuberculosis; the highest yield, acquired from the cervical group (52.8%), lowest from the inguinal region (4%).Conclusions: Our audit revealed significant diagnostic yield of lymph node biopsies from the supraclavicular region. Majority of them were of infectious aetiology and referred from General Medicine. This study supports the introduction of co-ordinated problem-based referral and management pathways for the management of patients with enlarged superficial lymph nodes, supported by regular audits of practice.
Bull gore injuries are one of the leading causes of morbidity and mortality in rural India, where people make their living rearing live stalk. There is also a significant rise in bull gore injuries following the festival of "Jallikattu" celebrated in southern India. This study was done to improve the understanding of the mode, severity and outcome of such victims. We conducted a retrospective descriptive analysis of victims suffering from bull gore injuries presenting to our Emergency Department (ED), from January 2017 to December 2018. During the study period, a total of 129 patients, with a mean age of 42.10 years, presented to the ED. There was a male predominance noted of 71.3%. According to our ED triage protocol, majority of the victims (60.5%) were triaged to priority 2. Most of the priority 1 patients suffered mild to moderate head injury or penetrating trauma to abdomen or thorax or both. Perineal injuries were noted in 11 patients, and visceral injuries (liver, kidney, spleen, bowel) were seen in 4 patients. The trauma specialities that were involved were trauma-general surgery 49 (38%), orthopaedics 30 (23.2%), plastic surgery 21 (16.3%), neurosurgery 19 (14.8%), and cardiothoracic surgery 11 (8.5%). About one third (32.6%) required hospital admission, and 60.5% of the victims were discharged from the ED after receiving primary care. Overall 21.8% victims had to undergo major surgical interventions. There was only one fatality and the rest were discharged in a stable condition. Management of bull gore injury is a challenge that requires multidisciplinary and well-coordinated approach for a successful outcome.
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