Inguinal hernia repair is one of the most frequently performed surgery. The ideal procedure for inguinal hernia repair remains controversial. Open Lichtenstein tension-free mesh repair (LMR) is one of the most preferred open techniques with satisfactory outcomes. Laparoscopic approach in inguinal hernia surgery remains controversial, especially in comparison with open procedures. In this study, we have reported a comparison of laparoscopic total extraperitoneal (TEP) inguinal hernia repair with LMR. Postoperative pain, operative time, complications like seroma, wound infection, chronic groin pain, and recurrence rate were parameters to evaluate the outcome. One hundred seventy-four patients were included in the study by consecutive randomized prospective sampling. The patients were divided into 2 groups: group A, laparoscopic TEP inguinal hernia repair, and group B, LMR. The procedures were performed by experienced surgeons. The primary outcomes were evaluated based on postoperative pain and recurrence rate. Secondary outcomes considered for evaluation were operative time, complications like seroma, infection, and chronic groin pain. Severe pain was reported in group A (7.9%) compared to group B (15.1%), which was statistically significant ( P < .001). Moderate pain was reported more in group B (70.9%) compared to group A (29.5%) ( P < .001). The mean operative time in group A was 84.6 ± 32.2, which was significantly higher than that in group B, 59.2 ± 14.8. There was no major complication in both groups. The chronic pain postoperatively was significantly in higher number of patients in group B vs group A (22.09% vs 3.4%). The postoperative hospital stay period was significantly lesser for group A vs for group B (2.68 ± 1.52 vs 3.86 ± 6.16). Time duration taken to resume normal activities was significantly lower in group A (13.6 ± 6.8) vs (19.8 ± 4.6) in group B ( P < .001). Although there is definite evidence of longer operative time and learning curve, laparoscopic TEP has added advantages like less postoperative pain, early resumption of normal activities, less chronic groin pain, and comparable recurrence rate compared to open Lichtenstein repair. Laparoscopic TEP can be performed with acceptable outcomes and less postoperative complications if performed by experienced hands.
Background: Tension free repair using mesh in open hernia repair has become more popular in recent years. Chronic pain remains a frequent complication after Lichtenstein inguinal hernia repair. The use of sutures to fix the mesh has been implicated. Fixing the mesh using cynoacrylate glue could avoid this complication. The purpose of the present study is to study the incidence of pain and other complications following inguinal hernia repair performed by the Lichtenstein technique with mesh fixation by cyanoacrylate surgical glue.Methods: T This study was conducted at tertiary care hospital. Inclusion criteria were all patients coming to the hospital with inguinal or inguinoscrotal hernias diagnosed clinically. Exclusion criteria were all complicated inguinal hernia namely obstructed, strangulated, and large hernias with scrotal abdomen, recurrent hernia. Patient not fit for surgery or not consenting to join the study. The patients will be informed about the surgery and thereafter requested to sign an informed consent. Primary outcome was postoperative pain. Secondary endpoints were operating time, surgical site infection and recurrence rate.Results: Total number of 31 cases enrolled in the study of which twenty-two had unilateral and seven had bilateral inguinal hernias. Average pain score on POD 1, 3, 7 was 5.75; 4.53; 3.32 respectively. One patient developed seroma which was managed conservatively. No evidence of recurrence during study period.Conclusions: Cyanoacrylate surgical glue is a reliable method and can be used as an alternative for conventional Lichtenstein hernia repair.
Introduction: Cholelithiasis is the most common and important cause of biliary tract disease. In today's world, laparoscopic cholecystectomy is the gold standard treatment for gallstones. Decrease in the size or number of ports provide better results in laparoscopic cholecystectomy. Objective: We aim the study to find out feasibility of three port lap cholecystectomy over four port lap cholecystectomy regarding post-op pain, duration of surgery, conversion rate, hospital stay and complications. Materials & Methods: Patients who fulfilled the inclusion criteria were included. 76 patients enrolled for the study and divided into two groups as 3 port and 4 port. Surgical preformed assessment proforma used to collect the data. Results: The mean age of the studied patients was 46.38 years with female preponderance. The Mean operative time for three ports was 66.90 minutes and for four ports it was 75.45 minutes. Mean duration of postoperative stay for three port was 4.66 and for the conventional group it was 5.30. Conclusion: Patients who underwent the three port technique had a lesser hospital stay compared to patients who underwent the conventional 4 port technique. Patients had less postoperative pain, lesser requirement of analgesics in three port group. 2 patients from the 4 port group had fever 48 hours after surgery.
Background: Liver is a common site for space occupying lesions. The objective of this study was to determine the aetiologies of space occupying lesion of liver and their clinical presentation and correlate imaging; to evaluate the treatment modalities of space occupying lesion of liver and their outcome.Methods: A 2-year tertiary care teaching hospital based longitudinal study with 63 patients was done. Selection criteria was defined and a prestructured proforma was made to assess and note the findings.Results: The mean age of occurrence of space occupying lesions of liver was 47.19±14.53 years. Space occupying lesions of liver was commonly observed in 5th decade of life. Males were affected more than females. Metastatic lesion of liver were the most common cause of liver SOL (34.9%) followed by liver abscesses.Conclusions: Majority of space occupying lesions are metastatic lesion followed by liver abscesses. Majority of space occupying lesions were surgically managed.
Abstract:Primary hydatid cyst of pancreas is rare. We report a case of a 26 year old male patient, who presented with upper abdominal pain. The imaging studies demonstrated a large pancreatic hydatid cyst along with two calcified hydatid cyst of liver. Large size of pancreatic cyst raised the possibility of communication of pancreatic cyst with pancreatic duct, hence roux en Y cystojejunostomy was carried out. Cysto-pericystectomy was done for liver cyst. Patient is asymptomatic on follow up for four years. We discuss the therapeutic modalities of this rare disease.
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