This study evaluated outcomes of 150 patients who underwent Lichtenstein hernioplasty for inguinal hernia over 2 years. Recurrence occurred in 1 patient (0.66%). Chronic groin pain was reported by 16 patients (10.6%) at 3 months, reducing to 3 patients (2%) at 2 years. Techniques to prevent chronic pain included identifying nerves, protecting them with fascia, and creating a lax external ring to avoid compression. Meticulous surgical technique can reduce chronic pain to below 1%.
Percutaneous Pedicle Screw Fixation For Thoracolumbar injuries using a low co...Ansarul Haq
The goal of PPSI is to decrease the trauma associated with the standard open approach, which can lead to significant devascularization and denervatation of the paraspinal musculature. This tissue trauma may be a contributing factor to patients’ chronic pain after surgery
Identifying Lateral Knee Pain Using Sodium Channel Blockers “Distally” at ankle.inventionjournals
Common complaint of lateral or para patellar knee pain seen in outpatient is sometimes perplexing. It is seen in younger age group may be labelled as chondromalacia, in midage seen as bursitis, tendinitis and aged group as osteoarthrosis or related pain. We have seen a new symptom and sign group of lateral knee pain. We have devised a clinical test to diagnose and confirm this pain by new methodology based on gore sign.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
Percutaneous Pedicle Screw Fixation For Thoracolumbar injuries using a low co...Ansarul Haq
The goal of PPSI is to decrease the trauma associated with the standard open approach, which can lead to significant devascularization and denervatation of the paraspinal musculature. This tissue trauma may be a contributing factor to patients’ chronic pain after surgery
Identifying Lateral Knee Pain Using Sodium Channel Blockers “Distally” at ankle.inventionjournals
Common complaint of lateral or para patellar knee pain seen in outpatient is sometimes perplexing. It is seen in younger age group may be labelled as chondromalacia, in midage seen as bursitis, tendinitis and aged group as osteoarthrosis or related pain. We have seen a new symptom and sign group of lateral knee pain. We have devised a clinical test to diagnose and confirm this pain by new methodology based on gore sign.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
Detailed discussion on diagnosis and management of TMJ ankylosis. Surgical anatomy and applied aspects of TMJ is discussed. Reconstruction of ramus-condyle unit is also discussed. Compications of TMJ surgery are also discussed
Failed Back and Neck Surgery Syndromes happen when a surgery to correct pain completely fails to alleviate the pain and in some cases makes the pain worse.
There are many reasons why a surgery could fail to provide results, both related to the patient and the surgeon.
How is it that a patient could cause a surgery to fail. A great example of this would be that a patient has undergone a spinal fusion to correct spinal instability in the lower back. The surgeon has advised the patient that smoking cigarettes which could severely reduce the healing chances and effect the fusion process. The patient ignores the doctor and continues to smoke and the fusion doesn’t heal. This is an example of the patient being at fault.
In what ways could a surgeon be at fault? There are many times that there is fault before the surgery is even performed. If there is an inaccurate diagnoses the surgery will be performed in the wrong area, and possibly the wrong surgery will be done. It is important to seek a second opinion of a specialist before proceeding with surgery of any kind. If two heads can agree on what and where the problem is, it is likely that there will be an accurate diagnosis.
One of the most common reasons for Failed Back and Neck Surgery Syndrome is that the surgeon is just not experienced enough in the technique being performed and he/she doesn’t perform it properly. This is why it is important to ask the right questions to the surgeon before moving forward with the surgery. How long have you been performing back surgeries? How long have you been performing this specific surgical procedure? and how many times a year do you perform this surgery.
Back and neck surgeries are procedures meant to be a permanent fix for a specific problem and correcting failed back or neck surgery is difficult.
Human spine is a complex structure that provides both mobility (so to bend and twist) and stability (so to remain upright). The normal curvature of spine has an “s”- like curve when looked at from the side. This curvature allows even distribution of weight and with stand stress.
Pain from acute vertebral fracture appears to be due in part to instability (non-union or slow union at the fracture site), while more than 1/3 of patients become chronically painful.
Traditional treatment for patients with painful VCFs includes bed rest, narcotic analgesics and bracing, resulting in increased pain because of acceleration bone loss and muscle weakness.
Fractures and fracture dislocations of the tarsometatarsal jointMurugesh M Kurani
Here I have discussed an article from Journal of Bone and Joint Surgery. The presentation includes classification, treatment, results and complications. Lets share and learn.
David: Femoral Neck Fracture with Avascular Necrosis of the Hip Case StudyDavid S. Feldman, MD
David is an avid hiker who fell and fractured his femoral neck during a hike. He underwent a successful surgery which fixed his femoral neck but later developed avascular necrosis of the hip. I ultimately recommended a multi-faceted course of treatment that included bisphosphonates, core decompression, BMP/Calcium phosphate, and arthrodiastasis. This course of treatment has successfully resolved his avascular necrosis of the hip and prevented the collapse of his femoral head.
http://www.davidsfeldmanmd.com/patient-education/case-studies/david-femoral-neck-fracture-w-avascular-necrosis-hip
Detailed discussion on diagnosis and management of TMJ ankylosis. Surgical anatomy and applied aspects of TMJ is discussed. Reconstruction of ramus-condyle unit is also discussed. Compications of TMJ surgery are also discussed
Failed Back and Neck Surgery Syndromes happen when a surgery to correct pain completely fails to alleviate the pain and in some cases makes the pain worse.
There are many reasons why a surgery could fail to provide results, both related to the patient and the surgeon.
How is it that a patient could cause a surgery to fail. A great example of this would be that a patient has undergone a spinal fusion to correct spinal instability in the lower back. The surgeon has advised the patient that smoking cigarettes which could severely reduce the healing chances and effect the fusion process. The patient ignores the doctor and continues to smoke and the fusion doesn’t heal. This is an example of the patient being at fault.
In what ways could a surgeon be at fault? There are many times that there is fault before the surgery is even performed. If there is an inaccurate diagnoses the surgery will be performed in the wrong area, and possibly the wrong surgery will be done. It is important to seek a second opinion of a specialist before proceeding with surgery of any kind. If two heads can agree on what and where the problem is, it is likely that there will be an accurate diagnosis.
One of the most common reasons for Failed Back and Neck Surgery Syndrome is that the surgeon is just not experienced enough in the technique being performed and he/she doesn’t perform it properly. This is why it is important to ask the right questions to the surgeon before moving forward with the surgery. How long have you been performing back surgeries? How long have you been performing this specific surgical procedure? and how many times a year do you perform this surgery.
Back and neck surgeries are procedures meant to be a permanent fix for a specific problem and correcting failed back or neck surgery is difficult.
Human spine is a complex structure that provides both mobility (so to bend and twist) and stability (so to remain upright). The normal curvature of spine has an “s”- like curve when looked at from the side. This curvature allows even distribution of weight and with stand stress.
Pain from acute vertebral fracture appears to be due in part to instability (non-union or slow union at the fracture site), while more than 1/3 of patients become chronically painful.
Traditional treatment for patients with painful VCFs includes bed rest, narcotic analgesics and bracing, resulting in increased pain because of acceleration bone loss and muscle weakness.
Fractures and fracture dislocations of the tarsometatarsal jointMurugesh M Kurani
Here I have discussed an article from Journal of Bone and Joint Surgery. The presentation includes classification, treatment, results and complications. Lets share and learn.
David: Femoral Neck Fracture with Avascular Necrosis of the Hip Case StudyDavid S. Feldman, MD
David is an avid hiker who fell and fractured his femoral neck during a hike. He underwent a successful surgery which fixed his femoral neck but later developed avascular necrosis of the hip. I ultimately recommended a multi-faceted course of treatment that included bisphosphonates, core decompression, BMP/Calcium phosphate, and arthrodiastasis. This course of treatment has successfully resolved his avascular necrosis of the hip and prevented the collapse of his femoral head.
http://www.davidsfeldmanmd.com/patient-education/case-studies/david-femoral-neck-fracture-w-avascular-necrosis-hip
Ligation-assisted endoscopic enucleation for the diagnosis and resection of s...Enrique Moreno Gonzalez
Ligation-assisted endoscopic enucleation (EE-L) was developed for the pathological
diagnosis and resection of small gastrointestinal tumors originating from the muscularis
propria. The technique combines endoscopic band ligation and endoscopic enucleation. The aim of this study was to evaluate the efficacy and safety of EE-L in the diagnosis and
resection of gastrointestinal tumors originating from the muscularis propria.
A Prospective comparative study of Local anaesthesia & Spinal anaesthesia for...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Sportsman’s hernia is a complex entity with injuries occurring at different levels in the groin region. Each damaged anatomical structure gives rise to a different set of symptoms and signs making the diagnosis difficult. The apprehension of a hernia is foremost in the mind of the surgeon. Absence of a hernia sac adds to the confusion. Hence awareness of this condition is essential for the general surgeon to avoid misdiagnosis.
Temporomandibular joint, a facial joint commonly undergoes internal derangement due to the abnormal position of the articular disc in relation to the condyle. Internal derangement of the TMJ is explained in detail in this presentation.
Similar to Outcome of lichtensteine hernioplasty (20)
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
How to Give Better Lectures: Some Tips for Doctors
Outcome of lichtensteine hernioplasty
1. NO CONFLICT OF INTEREST
DR. VENKATESH KAMEPALLI (PG)
BHARATI DEEMED UNIVERSITY MEDICAL
COLLEGE & HOSPITAL, SANGLI
DR.CHINMAY GANDHI ASSOCIATE PROFESSOR
OUTCOME OF LICHTENSTEIN
HERNIOPLASTY
2. INTRODUCTION
Inguinal hernia is the commonest surgical disease.
Altered ratio of collagen 1 and 3 causes weakness
of fascia.
Weakness in fascia transversalis causes hernia at
inguinal region, so we strengthen fascia
transversalis with mesh in Lichtenstein
hernioplasty.
3. STUDY DESIGN
This is the retrospective observational study of 150 inguinal
hernia operated by Lichtenstein tension free hernioplasty at
our institute from 2012 to 2014.
Surgeries were done by residents and faculties.
All patients were above 18 years having unilateral non
strangulated inguinal hernia .
Patients were followed for 2 years postoperatively for
recurrence and chronic groin pain.
.
7. ilihypogastric iliinguinal nerves were seen. Pre
hernia cord lipoma excised to prevent hernia
recurrence.
Indirect sac
dissection from
cord structures up
to retro
peritoneum,
reduction of its
content, inversion
of small indirect
sac ,ligation of the
neck of the large
indirect sac, cutting
across the body and
keeping rest of sac
open.
8. Strengthening of
posterior wall of
inguinal canal
with 6 X 4 inch
polypropylene
mesh was done in
all cases. 2cm
Overlap on medial
side of pubic
tubercle was given
. Lower edge of
mesh was sutured
with
polypropylene 2-0
suture to shelving
part of inguinal
ligament from
pubic tubercle to
internal ring level.
9. Lateral edge of
mesh was cut
approximately
1/3 from lower
edge to make
two tails of mesh
this is done to
accommodate
cord structures
at internal ring.
Anuloplasty
done to make
new internal
ring from mesh.
5 cm overlap of
mesh lateral to
internal ring was
given.
10. Mesh should form a loose dome over the posterior
inguinal wall. Incised external oblique aponeurosis
was sutured with 2-0 polypropylene suture with
creation of new lax external ring.
Medial fixation of
mesh on to anterior
rectus sheath.
Superiorly 3 cm
overlap was given
above Hasselbachs
triangle.
Fixation is also
done at medial and
superior to internal
ring through
internal oblique
muscle.
11. Study follow up
Follow up was done in out patient department and
by telephonic conversation.
All patients received prophylactic cefotaxim 1 gm.
2 hrs prior to surgery
12. Out of 150 operated patients
141 were male and 9 female.
141
9
Male
Female
13. Nyhus distribution of type of hernia
Nyhus type 1: Indirect hernia with normal internal ring (54
PATIENTS)
Nyhus type 2: Indirect hernia with dilated internal ring,
posterior wall intact(15 PATIENTS)
Nyhus type 3 A: posterior wall defect direct inguinal hernia
(66 PATIENTS)
Nyhus type 3 B: Indirect inguinal hernia ring dilated with
posterior wall defect (11 PATIENTS)
Nyhus type 3 C: Femoral hernia ( NO PATIENTS)
. Nyhus type 4: Recurrent hernia(4 PATIENTS)
14. Results for recurrence of hernia
149 patients had no recurrence on 2 years follow-up.
One patient had recurrence of hernia within 1 year of
surgery.
We had used polypropylene mesh, with wide overlap
expecting 20 to 40% mesh contracture in future. This had
given only 0.66% recurrence in our study.
15. Results at 3 month for
chronic groin pain .
Results of chronic groin
pain at 2 years
Out of 150 patients 16 had
mild pain on 3 month
follow-up.
10.6% patients had mild
pain at 3 month follow-
up.(four point verbal rating
scale used for measuring
groin pain)
There was not a single case
of severe or moderate groin
pain requiring emergency or
late surgical intervention.
Out of 150 patients 3 had
mild pain at 2 years.
2 % mild pain after 2 year
follow up.
One patient complained of
heaviness and hyperesthesia
in inguinal region.
(Neuropathic mild pain )
Two had intermittent mild
groin pain(somatic pain)
relived with mild anti-
inflammatory analgesics.
POST OPERATIVE CHRONIC GROIN PAIN
17. TECHNIQUES WE FOLLOWED TO PREVENT CHRONIC GROIN
PAIN
Nerves ilioinguinal, ileohypogastric and genital branch of
genitofemoral nerve were identified with meticulous dissection,
preserving investing layer of fascia over it.
Not lifting ilioinguinal nerve from bed.
Genital branch of the genitofemoral nerve is located in the cord along
with external spermatic vein, covered and protected from direct contact
with mesh by the deep cremastric fascia. It should be kept with the
cord, while the cord is separated from inguinal floor using blunt peanut
dissection, grasping the cord with thumb and index finger should be
avoided.
Creating lax external inguinal opening to prevent compression of
ilioinguinal nerve.
18. TECHNIQUES WE FOLLOWED TO PREVENT CHRONIC
GROIN PAIN
Iliohypogastric is easily visible after superior anatomical
dissection between external and internal oblique muscle. It
has to be safeguarded by splitting mesh and preserving
fascia over it.
Should wait more than 6 months before surgically treating
chronic groin pain disturbing daily activity.
Severe pain should be treated immediate postoperative.
19. Take home message
. Meticulous technique can reduce chronic groin pain
up to 0.5% after Lichtenstein hernioplasty
.Use of Light weight mesh( between 35 to 70gm/m2)
recommended in Lichtenstein hernioplasty.
.Lichtenstein hernioplasty can bring recurrence below
1%.
Lichtenstein hernioplasty has short learning curve for
residents, results can be reproduced.
Lichtenstein hernioplasty gives satisfactory long term
results to community
20. REFERENCES
1) Jack Abrahamson, Hernia. Seymour Schwartz’s and Harold Ellis. Edited Maingot’s abdominal operations. 9th edition Connecticut, Appleton & Lange, 1990. P.215-296
2) Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension free hernioplasty. Am J. Surg.1989 Feb; 157(2):188-93)
3) Chen DC. And Amid PK. Technique: Lichtenstein, Bruce Ramshow, Edited. The SAGES Manual of hernia repair. New York, Springer, 2013.p.41-5
4) Inguinodynia A SAGES Wiki Article
5) Callesen T, Bech K, Kehlet H, Prospective study of chronic pain after groin hernia repair. Br. J. Surg. 1007 Dec; 86(12):1528-31
6) Hakeem A. and Shanmugam V. Current trends in the diagnosis and management of postherniorraphy pain. World J Gastrointestinal Surg. June 27 2011; 3(6): 73-81
7) O’ Dwyer PJ, Alani A, McConnachie A. Groin hernia repair: postherniorraphy pain. World J Surg.2005; 29:1062-1065
8) Robert E, Condon MD, Groin pain after hernia repair. Ann Surg. Jan 2001; 233(1):8
9) Smed’s, Lofstrom L, Ericsson O. Influence of nerve identification and resection of nerve at risk on postoperative pain in open inguinal hernia repair. Hernia, 2010; 14:265-270
10) H.S.Sajid, C Leaver, M.K.Baig, P.Sains. Systemic review and meta- analysis of the use of lightweight versus heavyweight mesh in open inguinal hernia repair. bjs.volume
99.Issue 1. 31st oct.2011
11)Bringman S, Wollert S, Osterberg J, Smedberg S, Granlund H, Heikkinen T J. Three year results of a randomized clinical trial of lightweight or standard polypropylene mesh in
Lichtenstein repair of primary inguinal hernia. Br.J.Surg.2006.Sep; 93(9):1506-9
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