Background: OH (occult hernias) refer to those hernias which are not evident on clinical examination, but which are noted either on surgical exploration or on good quality pre-operative imaging. Identifying them in day-to-day practice is of immense importance in view of unexplained and undiagnosed symptomatology, post-operative recurrences and cost effectiveness. The main objective of this paper is to study the incidence of occult hernias diagnosed intra-operatively during laparoscopic groin hernia surgery.Methods: In this retrospective study, we identified 723 patients who underwent laparoscopic repair of groin hernia in our institute by a single surgeon, from 2008 to 2021. OH were found in 120 patients, all during totally extraperitoneal approach (TEPA) and none during transabdominal pre-peritoneal approach (TAPP). The age range of these 120 patients was 22 to 83 years (mean: 60.7 years with SD: ±12.5 years). The patients were also analysed for sex, type of OH, side of OH and post-operative outcomes.Results: Incidence of OH in our study was 16.59% (120 out of 723 patients). OH were found in both male as well as female patients. These comprised of unilateral and bilateral OH. Patients with unilateral OH heavily outnumbered those with bilateral OH (n=117 vs. 3). There were 3 different types of OH in our study-inguinal, femoral and spigelian. The maximum number of cases were of inguinal OH (n=115). Among inguinal OH, patients with direct OH outnumbered those with indirect OH (n=73 vs. 40).Conclusions: Awareness about OH as an entity is important, as their identification and concurrent repair possibly spares the patient another surgical intervention at a later date.
: Objective: Acute appendicitis is one of the common abdominal emergencies encountered in surgical practice. However there are a host of other medical and surgical conditions that closely mimic it, clinically. The objective of this paper is to present a study and analysis of our burden of incidental encounters with such mimicking surgical conditions that were erroneously diagnosed as acute appendicitis, prior to surgery. Methods: Data was retrieved from the hospital’s electronic medical records about all patients operated for acute appendicitis, by a single surgeon, over a 14 year period. Results: A total of 450 patients were operated for acute appendicitis from 2008 to 2022. Out of these, we identified 20 patients who had a normal appendix with some other mimicking surgical condition (Incidence 4.44%). Conclusion: Acute appendicitis has many differential diagnoses, both common and rare. At times, some of these are confirmed ‘on table’; as seen in this case series. A sound, reliable and fool proof palpatory assessment of the abdomen is crucial in diagnosing it’s surgical conditions. It is interesting to note that although the initial diagnosis of acute appendicitis made for all the subjects of this case series was erroneous, all still turned out to have alternate conditions which merited surgery.
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