Background: Laparoscopic inguinal hernia repair has become increasingly popular as an alternative to open surgery. Aim: To evaluate total extraperitoneal repair with direct telescopic dissection and mesh hernioplasty for inguinal hernias.Methods: This study was conducted at General Surgery department the period of 1 year on 30 patients having inguinal hernia.Results: This prospective study included 30 adult patients with primary unilateral inguinal hernia, all of them were males. Age of study patients ranged from 22 to 64 years old. Intraoperatively, 6 patients were presented to have direct inguinal hernia (20%) while 21 patients had indirect inguinal hernia (70%). In 3 patients, combined direct and indirect hernia defects were present (10%). Mean operative time was 99.30±25.13 min. Mean time for analgesia was 3.62±1.57 days. Hospital stay mean was 1.43±0.62 days. The mean time until return to work was 14.1±3.13 days, the mean time of follow up was 7.1±2.2 months. Intra operatively 5 (15%) and post operatively 8 (26.6%)complications were observed.Conclusions: Laparoscopic TEP repair is an excellent alternative to open preperitoneal repair of inguinal hernia. Complication rate was average with other studies while there was no hernia recurrence during the period of follow up.
Background: Hypocalcemia is one of the most common complications of thyroidectomy. Hence, parathyroid hormone (PTH) measurement can be used to predict patients at risk for developing significant postoperative hypocalcaemia after thyroidectomy. The present study was conducted with the objective to find out whether there is any correlation between intact PTH value and patients developing symptoms of hypocalcemia after total thyroidectomy and to determine the threshold value of 1 hour post total thyroidectomy (intact PTH level) that can identify those at high risk for developing symptomatic hypocalcemia.Methods: Study involved determination of serum calcium, creatinine and albumin preoperatively, serum intact PTH, 1 hour after completion of total thyroidectomy (i.e. after the closure of skin incision), and serum calcium levels 6, 24 and 48 hours postoperatively. Clinical findings suggestive of hypocalcaemia were also watched for and recorded. Symptomatic signs and/or symptoms were recorded. The patients were followed up for 3 days post operatively and the lowest recorded serum calcium was taken into account. The results were tabulated and entered in Microsoft excel and analysed with spss 17 statistical software.Results: 26% of the study population developed hypocalcemia. Intact PTH was found to be lower in patients who developed symptoms of hypocalcemia. There was a statisticantly significant correlation between the two groups. A one-hour Intact PTH value of 14 pg/ml was found to have high sensitivity (92.3%) and specificity (91.9%).Conclusions: Hypocalcemia is the most common complication after total thyroidectomy. Intact PTH measurement one hour after total thyroidectomy can be used to predict the patients who will develop hypocalcemia after total thyroidectomy. Therefore, patients having low one-hour intact PTH value could be started on calcium supplementation and those having high PTH could be safely discharged early.
Background: The aim of the study was to determine the number of parathyroid glands that need to be preserved to prevent hypoparathyroidism and to understand the relation between the number of parathyroid glands preserved and hypoparathyroidism.Methods: A retrospective study was performed on 350 patients who had undergone trans cervical total thyroidectomy with or without neck dissection for papillary thyroid carcinoma between July 2010 to August 2015.Results: Incidental parathyroidectomy occurred in 19.1% of patients, one parathyroid gland in 17.8%, two in 2% and 3 in 0.5%. Transient hypoparathyroidism increased when incidental parathyroidectomy occurred on multivariate regression analysis, but it was not influenced by the actual number of parathyroid glands removed. There was no relationship between the number of parathyroid glands preserved and hypoparathyroidism.Conclusions: It is not compulsorily required to prevent permanent hypoparathyroidism, but the preservation of all the four parathyroid glands during thyroidectomy decreases the incidence of transient hypoparathyroidism. When auto transplantation is not performed, to prevent permanent hypoparathyroidism, preserving at least one parathyroid gland with an intact blood supply is sufficient.
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