RESUMO
Background Primary ventral hernias are abnormal protrusions of abdominal viscera through the areas of weakness in the fascia of the abdominal wall. The aim of this study was to compare the benefits and complications, and the overall outcome in the Extended-View Totally Extraperitoneal Rives-Stoppa (eTEP-RS) repair versus Intraperitoneal Onlay Mesh (IPOM Plus) repair in the management of primary ventral hernias. Methods After obtaining institutional ethical committee clearance, this prospective comparative study between IPOM Plus and eTEP-RS was conducted in a tertiary care hospital from December 2020 to January 2022. A total of 50 patients presenting with primary ventral hernias were included in the study, of whom 25 underwent IPOM Plus and 25 underwent eTEP-RS repairs. Group selection was done by simple randomization using the lottery method. Patients more than 18 years of age with primary ventral hernias presenting with a hernial defect width less than 6 cm, consenting to the study, were included in the study. Patients who did not fulfill the inclusion criteria, strangulated/obstructed hernias, recurrent/incisional hernias, connective tissue disorders, skin infections, enterocutaneous fistulas, pregnancy, morbid obesity, and parastomal hernias were exclusion factors. Results The mean intraoperative duration in the eTEP-RS group (192.3 ± 16.20 min) was significantly higher than in the IPOM Plus group (102.6 ± 16.78min, p=0.001). The mean duration of hospital stay in the IPOM Plus group (5.9 ± 2.19 days) was longer than in the eTEP-RS group (4.6 ± 3.17 days, p=0.02). The mean postoperative pain scores, from the Visual Analogue Scale (VAS), on days 1, 7, and 90 were 3.2 ± 1.11, 2.64 ± 1.11, and 1.68 ± 1.46 in the IPOM Plus group and 1.84 ± 0.688, 0.76 ± 0.66 and 0.08 ± 0.40 in the eTEP-RS group, respectively (p=0.001). Conclusion Despite being a technically easy procedure requiring less intraoperative time, IPOM Plus had several disadvantages, such as increased postoperative pain, longer duration of hospital stays, higher chances of wound site seromas, and higher rates of postoperative paralytic ileus. On the other hand, eTEP-RS was a more challenging procedure requiring more intraoperative time; however, it had several advantages: less postoperative pain, less duration of hospital stay, early recovery, and fewer chances of seromas and paralytic ileus. However, more robust data is required to compare and validate the differences between both procedures' short- and long-term outcomes.
RESUMO
Background The aim of this study was to validate the pros of laparoscopic appendectomy (LA) over open appendectomy (OA) and to compare various primary outcome measures in the management of acute and recurrent appendicitis. Study Design Prospective comparative study. Place and Duration Between June 2015 and October 2019 in JJ Hospital, Mumbai. Materials and Methods Total of 60 patients with acute and recurrent appendicitis were included in the study. Thirty patients underwent OA and 30 underwent LA. Both groups were comparable clinicopathologically and demographically. Various intraoperative and postoperative parameters were compared. Continuous variables were expressed as mean ± standard deviation and categorical variables were expressed as percentages. Mann-Whitney U test was used to compare continuous variables and chi-squared test was used to compare categorical variables. p -Value≤0.001 was considered to be statistically significant. Results The median age of patients undergoing OA and LA was 24.9 and 25.2 years ( p = 0.221), respectively. Female: male ratio in OA and LA was 1.30 and 1.14, respectively ( p = 0.795). Mean operative duration in LA and OA group was 47.17 ± 14.39 minutes and 36.9 ± 12.33 minutes ( p = 0.001), respectively. Mean length of postoperative stay in LA and OA group was 3.69 ± 0.71 days and 5.28 ± 0.63 days ( p = 0.000), respectively. Median visual analogue scale score in LA and OA group was 3.5 and 5 ( p = 0.001), respectively. Mean time to return to normal activity in LA and OA group was 8.13 ± 1.33 days and 10.10 ± 2.20 days ( p = 0.000), respectively. About 6.66% patients in LA group and 13.33% in OA group had postoperative wound infection ( p = 0.652). Mean scar scale scoring done on 30th postoperative day was 4.23 in LA and 8.23 in OA ( p = 0.000). Discussion and Conclusion LA is more promising than OA in the management of acute and recurrent appendicitis. LA offers lesser operative site pain in the postoperative period, shorter postoperative hospital stays, earlier recovery, and return to normal activities and cosmetically better scars on 30th day follow-up. No conversions or significant difference in wound related complications were seen in both groups. Prolonged intraoperative duration was the only drawback of LA.
RESUMO
Mesenteric cysts are rare abdominal lesions in the mesentery of the intestine. Complete surgical excision is the only treatment which can be done by an open laparotomy or laparoscopic technique. Application of indocyanine green dye during the surgery helps in identification of the mesenteric vasculature, prevention and early repair of inadvertent iatrogenic vascular and bowel injury.
