Hybrid Technique for Abdominal Wall Hernia Repair: Description and Early Results.

Objective Ventral hernia repair is a widely practiced surgical procedure worldwide. The objective of this paper is to evaluate and analyze the results of a hybrid approach for treating ventral hernias. Methods All patients with clinically and radiologically proven ventral hernia underwent hybrid laparoscopic ventral hernia repair at Princess Royal University Hospital, London, United Kingdom using a retrospective approach with the same surgical team. Large defects >10 cm, inguinal hernia, para-stomal hernia, incarcerated patients, and spigelian hernia were excluded. We utilized the laparoscopic approach for the dissection and isolation of the sac and used the port site for the delivery of mesh into the abdominal cavity. Results Our study comprises 67 patients, with 39 males (58.2%) and 28 females (41.8%). The median age in our study group was 41 years (range: 18-65 years). The median BMI was 38 kg/m2 (range: 24-52 kg/m2). The majority of the cases were umbilical or paraumbilical hernias (n = 46). The median defect size in our study was 5.4 cm (range: 2-10 cm). The median operative time was 67 minutes. We have not encountered any recurrences in this group. Conclusion This hybrid approach combines the advantages of both the open and laparoscopic approaches.

Technical Tips Following 850 Consecutive One Anastomosis Gastric Bypass (OAGB) Patients.

Background: The surgical procedure One Anastomosis Gastric Bypass (OAGB) has become widely used worldwide. Since its inception, many modifications have been introduced to improve results. Objectives: The primary aim of this study was to share the modifications that we have introduced to our OAGB technique after reflecting on the problems and complications we have faced during the evolution of this procedure in our unit. Method: A total of 850 patients who underwent OAGB under the same surgical team at two different hospitals in the United Kingdom were displayed according to demography and comorbidities. All complications were reviewed and analysed to instigate the changes in our technique. Results: There were 756 (89%) primary and 94 (11%) revisional procedures. There were 596 females (70.11%) and 254 males (29.89%) in our study group. The body mass index range was 32-84 and the mean was 45. The pre-operative weight range was 89-274 kg and the mean was 126.4 kg. Conclusions: With experience and reflecting on our complications we have modified our surgical approach, and these alterations have helped us to adopt OAGB as the mainstream bariatric procedure. We want to share our experience with the bariatric community for the benefit of patient care.

Carpal tunnel syndrome ascribed to low-dose combined oral contraceptive pills.

Carpal tunnel syndrome (CTS) is the most prevalent compressive focal mononeuropathy brought on by median nerve compression, and common manifestations include pain in the wrist joint, decreased sensations along the distribution of the median nerve, a reduction in two-point discrimination, nighttime awakening, and, in more advanced stages, thenar muscle wasting and weakening. CTS, although common, yet underreported adverse effects of oral contraceptives. We report a case of 21-year-old female who developed CTS after using low-dose combined oral contraceptive pills for irregular cycles with polycystic ovary disease.

A comparative study on third trimester fetal biometric parameters with maternal age.

Background: Advanced maternal age is an important parameter associated with increased risk of feto-maternal complications and it is an evolving trend in society for women planning for pregnancy in late ages. However there are no studies done whether advanced maternal age has its effects on expression of growth pattern in the fetus. So this study was done to compare the maternal age with the third trimester fetal biometric parameters. Methods: This study was done in 100 antenatal women and divided into two groups: Group 1: optimal maternal age group between 21-29 years of age and Group 2: advanced maternal age 30 and above. The pre-pregnant maternal weight, gestational age and third trimester fetal biometrics using ultrasound are noted and compared between the groups. Results: The maternal weight gain between the groups was optimal but the third trimester fetal parameters were significantly less in advanced maternal age. The abdominal circumference in optimal age group and head circumference in advanced maternal age group was closer to calculated estimated date of delivery (EDD) and would be specific in calculating the gestational age. Conclusions: Though there is no significant difference in maternal weight gain, there are fetal growth restrictions in advanced maternal age group due to which the third trimester fetal parameters are lesser than the optimal age group. Head circumference would be specific in calculating the estimated date of delivery in advanced maternal age group.