Efficacy Of Local Anaesthesia In Repair Of Inguinal Hernia.

BACKGROUND: Local anaesthesia has been identified as the most favourable anaesthesia for elective inguinal hernia repair with respect to complication rate, cost effectiveness and overall patients' satisfaction. This study was conducted to determine the efficacy of local anaesthesia in inguinal hernia in terms of pain relief, wound infection and hospital stay. METHODS: In this randomized controlled trial (RCT), 60 patients with inguinal hernia were included at the General Surgical 'B' Unit, Ayub Teaching Hospital Abbottabad. RESULTS: The day-case rates were significantly higher when patients underwent surgery under LA compared to GA (82.6% versus 42.6%). The incidence of urinary retention was higher in the GA group (p<0.05). There were 17 (2.9%) re-admissions overall. The reasons for readmission included haematoma (n=6), severe pain (n=4), infection (n=3), fainting (n=2) and urinary retention (n=2). CONCLUSIONS: This study demonstrates that local anaesthesia for inguinal hernia repair has better efficacy as compared to general anaesthesia.

Outcome Of The Choice Of Wound Closure Technique In Emergency Laparotomy.

BACKGROUND: Abdominal surgeries are the most common surgeries performed around the world. Closure of abdominal wound is important and a number wound closing techniques are in practice. This study was conducted to determine the outcome of the choice of wound closure technique in emergency laparotomy. METHODS: It was a retrospective study from March-September 2019, conducted at the Surgical A unit, Ayub Teaching Hospital, Abbottabad. Ninety-five patients aged 22-60 years, who underwent emergency laparotomies via midline and para-median incisions were included in the study. RESULTS: There were 74 (77.89%) males and 21 (22.11%) females. Anatomical closure technique was used in 67 (70.53%) of study participants while mass closure technique was used in 28 (29.47%) of study participants. 50 (52.63%) patients had anaemia, 27 (28.42%) had hypo-proteinemia, and 14 (14.74%) developed peritonitis. Post-operative wound infection was noticed in 15 (15.79%) patients. Out of 95 patients, 19 (20%) developed burst abdomen. Overall, 5 (5.26%) patients died in the hospital. All cases of burst abdomen occurred within first two weeks of hospital stay (p= 0.004), had an association with peritonitis (p=0.0001) and post-operative wound infection (p= 0.005). Wound closure technique was not associated with development of post-operative complications including burst abdomen (p >0.05). CONCLUSIONS: Postoperative complications occur independently of wound-closure technique and surgeons should have a low threshold for prevention of post-operative complications where possible.

Evaluation Of Darn Repair For Recurrence Rate In The Management Of Indirect Inguinal Hernia.

BACKGROUND: Management of Inguinal Hernia had long been remained an enigma & various method had been employed for its management till date. Recent trend is towards the preferential use of mesh in open as well as Laparoscopic approaches where its advocates almost always undermine the role of raphys in the management of inguinal hernia but Darning repair despite all this critique is still a valid & viable option for the management of Indirect inguinal hernia. METHODS: This descriptive study was designed & carried out at the surgical units of Ayub Teaching Hospital Abbottabad from February 01, 2016 to October 31, 2018. A total of 117 patients with indirect inguinal hernia (primary) were included in study, managed with Darn Repair & were later followed for 2 years for the evidence of recurrence. RESULTS: None of the included patients (followed till last) whom underwent Darning Repair for Indirect Inguinal Hernia were found with the complication of recurrence till 02 years of follow-up although few patients were lost to follow-up for the whole duration 02 years and few others had suffered other early complications like wound infection, seroma, haematoma formation, scrotal swelling or comparatively longer lasting post-operative pain. The Darn Repair was also found cost-effective as compared to Mesh repair. CONCLUSIONS: Darn Repair despite criticism is a viable & effective option for Indirect Inguinal Hernia Repair (where its role indeed is prophylactic {NOT curative} against the future false recurrence), having no recurrence rate (as per our study results) like mesh repair (as per published literature) besides being reasonably cost-effective.