BackgroundInguinal herniorrhaphy remains one of the most common general surgical operations, with approximately 15% performed for recurrence. The repair of the resulting recurrent hernia is a daunting task because of already weakened tissues and obscured and distorted anatomy. The aim of this study is to compare the posterior preperitoneal versus anterior tension-free approach for repair of unilateral recurrent inguinal hernia regarding complications and early recurrence.Methods120 Patients in this study were divided randomly into 2 main groups; Group A patients were subjected to posterior preperitoneal approach and those of group B were subjected to conventional anterior tension-free repair. The primary end point was recurrence and the secondary end points were time off from work, postoperative pain, scrotal swelling and wound infections.ResultsThe mean hospital stay was 1.2 days and 4.7, the mean time to return work was 8.2 and 11.2 days and the mean time off from work was 9.4 and 15.9 days in group A and B respectively. The maximum follow-up period was 48 months and the minimum was 14 months with a mean value as 37.11 ± 5.14 months. Only 2 recurrences (3.3%) in group A and 4 cases (6.25%) in group B were seen. The final pain score per patient and the overall complication rate were higher in group B.ConclusionsThe open preperitoneal repair offers the advantages of low recurrence rate and allows covering all potential defects with one piece of mesh and is far superior to the anterior approach.Trial RegistrationACTRN12611000337976

Background Data: Siamese twins are joined by a part of their body at birth and the causes of the merger are often unknown. When the merger is on the spine it is rachipagus. It is an extremely rare and strange condition, and there are only a few documented cases in the literature. We present one additional case of parasite rachipagus on the dorsolumbar level. Purpose: Our aim is to describe a girl with a parasitic twin attached to her lower back, combined with a spina bifida and a lipomyelomeningocele. Study Design: Case report and review of the literature Patient and Method: In September 2014, a female baby from North Sinai was referred to Suez Canal University Hospital. She was 1 month old and had an extra well developed parasitic twin attached to her back. She was surgically treated in the Neurosurgery and Pediatric Surgery Departments. Results: A rare example of rachipagus conjoint parasitic twinning in a newborn girl is described. A lipomatous mass, a rudimentary intestinal loop with an attached atrophic pelvis and hind limb were found adherent to the dorsal vertebral arches of the autosite in the thoracolumbar region. Surgical excision of the parasitic twin, excision of the dorsal lipoma, repair of the cord and wound repair were done Conclusion: Parasitic rachipagus is a rare embryogenic malformation with a good surgical prognosis on the autosite in the absence of associated congenital anomalies. (2016ESJ111)

Introduction: Pediatric inguinal hernia is a common surgical problem with cumulative incidence of 4.2%.Minimal invasive surgery role is growing in the treatment of this problem. We compared the outcome of laparoscopic sutureless herniotomy and purse string with sac dissection repair regarding complications and operative time.Methods: one hundred fty two patients were operated in two centers with two different techniques: Sac dissection and purse string suture and sutureless repair. Operative time and recurrence were the main outcomes of comparison.Results: Sutureless repair has shorter operative time (29±10 minutes) compared to purse string repair (38±13 minutes). The recurrence rate showed no statistical signi cance difference. However, the recurrence rate of Sutureless repair was three folds higher than the purse string repair and all recurrences were in large defects of 10-15 mm. Conclusion: Sutureless repair is safe for defects up to 10 mm with excellent operative time. However, it had an unfavorable outcome in larger defects.

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Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

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Introduction: Pediatric inguinal hernia is a common surgical problem with cumulative incidence of 4.2%. Minimal invasive surgery role is growing in the treatment of this problem. We compared the outcome of laparoscopic sutureless herniotomy and purse string with sac dissection repair regarding complications and operative time. Methods: one hundred fifty two patients were operated in two centers with two different techniques: Sac dissection and purse string suture and sutureless repair. Operative time and recurrence were the main outcomes of comparison. Results: Sutureless repair has shorter operative time (29±10 minutes) compared to purse string repair (38±13 minutes). The recurrence rate showed no statistical significance difference. However, the recurrence rate of Sutureless repair was three folds higher than the purse string repair and all recurrences were in large defects of 10-15 mm. Conclusion: Sutureless repair is safe for defects up to 10 mm with excellent operative time. However, it had an unfavorable outcome in larger defects. Research and ethical committee approval number: D-11-2020