A Prospective Randomized Controlled Study of Lichtenstein's Tension Free versus Modified Bassini Repair in the Management of Groin Hernias.

BACKGROUND: Bassini's repair and the Lichtenstein's tension free mesh hernioplasty are commonly used hernia repair techniques. A prospective randomized controlled study of Lichtenstein's tension free versus modified Bassini repair in the management of groin hernias was undertaken to compare the technique and postoperative course in the two procedures. METHODS: A prospective study was conducted on patients reporting to Command Hospital (SC) Pune with inguinal hernia. One hundred and ninety six patients were included in the study, operated upon by either of technique and followed up. RESULTS: Study involved 196 patients with 216 primary inguinal hernias, studied over a period of 24 months. A total of 118 Bassini repair and 98 Lichtenstein's repair were done. Of the 196 patients, four were females. Bassini Repair took more time than Lichtenstein's repair, though the difference was not statistically significant (p>0.05). Direct hernias took lesser time to operate than the indirect hernias. Pain on the operative day, in the evening, was similar in both the groups. The commonest complication in both the groups was scar tenderness followed by erythema, scrotal swelling, neuralgia, superficial wound infection, funiculitis and seroma formation in the order of frequency. The average hospital stay was 5.74 days for Bassini's repair as compared to 4.97 days for Lichtenstein's repair. Patients undergoing Bassini's repair took longer (mean 28.4 days) to return to work as compared to those who underwent Lichtenstein's repair (mean 21.4 days) and the difference was statistically significant (p < 0.05). The recurrence rate was similar in Bassini's (6.78%) and Lichtenstein's repair (5.10%). CONCLUSION: The Lichtenstein's tension free mesh hernioplasty was comparatively better than modified Bassini's repair due to its simplicity, less dissection and early ambulation in the postoperative period. Surgeons in training found the technique easier to master than the Bassini's repair.

Medical problems in surgical patients.

OBJECTIVES: There has been an increase in surgical cases due to physical violence, accidents and weapon related injuries. This study was undertaken to assess the medical problems in general surgical cases and due to various injuries. METHODS: All general surgical cases and casualties arising out of weapon related, accidents and blunt injuries admitted to a zonal hospital over a period of one and half years were studied. Only cases who developed a medical illness due to surgical cause, anaesthetic or surgery were included. Evaluation and treatment was done alongwith the surgeon till discharge/death. Details were analysed to ascertain the type of surgical illness, medical complication and the outcome of treatment. RESULTS: There were seven hundred sixty two (53.8%) general surgery cases and six hundred fifty four (46.2%) cases due to various injuries. After excluding cases with prior known medical illness, thirty seven patients were studied. There were eight (1.05%) patients out of seven hundred sixty two general surgery cases and twenty nine (4.43%) out of six hundred fifty four injury cases. Weapon related injury cases were the maximum. Their medical problems related to the organ injury, fat embolism and sepsis. Soft tissue injury was next common, they all developed renal failure. Vehicle accident victim(3) were few and developed fat embolism, aspiration. Two patients out of thirty seven succumbed to post anaesthetic complications. CONCLUSION: The incidence of medical problem in injury related cases are more than in general surgery cases. The type of injury contributes to the medical problem. Increase in mortality and morbidity is because of emergency nature of surgery. This problem needs special study.

Sutureless closure of Operative Skin Wounds.

Good tissue union and cosmetically acceptable scar is vital for ideal surgical practice. Since their discovery in 1949, cyanoacrylate compounds have evoked interest as being the ideal "tissue glue". Several different forms of this compound have been developed in order to eliminate tissue toxicity. In this article, we have described a technique of sutureless closure of operative skin wounds and compared it to closure of skin with silk. Inter-group comparison was carried out with respect to the time required for closure, rate of infection, cosmesis and patient acceptance. N-butyl 2-cyanoacrylate was used for sutureless skin closure in 100 patients and compared with skin closure with sutures. The time taken to close the wounds with cyanoacrylate was found to be significantly less, the cosmetic outcome better and patient acceptability higher than when sutures were used.

Fecal Incontinence after Posterior Sagittal Anorectoplasty - Follow up of 2 years.

After an anorectal malformation (ARM) is repaired, the goal is fecal continence of the patient. Toilet training is not complete in children below 4 years of age. Manometric and radiological studies need cooperation of the child, and are therefore of little value during the critical preschool years. In this present study, we used only clinical criteria to assess the child for constipation and incontinence after definitive operation. We included all patients of ARM wef 01 April 1998 to 31 March 2000. Only 2 children had crossed 4 years of age at the time of this assessment and therefore it was not possible to assess total continence postoperatively. We found that the incidence of incontinence was less in low anomalies and more in high or intermediate anomalies, while the incidence of constipation was higher in low anomalies and less in high and intermediate anomalies. 31% of all patients born with anorectal malformations and subjected to posterior sagittal anorectoplasty (PSARP) approach were totally continent, 38% suffered with soiling of faeces while 31% had problems of constipation. The higher incidence of constipation as well as incontinence in our study is because of a short follow-up and secondly, these problems are known to improve with passage of time. The purpose of this article is to highlight the problems of bowel control even after the definitive operation and still much more is required to improve the quality of life of these unfortunate children.

War Wounds - Changing Concepts.

The accepted standard treatment of war wounds through the last century has been debridement and delayed primary closure. However, recently, there has been a renewed Interest In primary closure of these wounds. 1481 war wounds were managed by the authors and out of 789 soft tissue injuries, 389 (47%) were closed primarily (group 1) after meticulous debridement and 220 (28%) underwent delayed primary closure (group 2). The infection rate in group 1 was 4.87% compared to 6.36% in group 2. The average hospital stay in group 1 was 15 days, significantly shorter by 10 days than in group 2. In the war zone both time and resources are at a premium and primary closure of selected wounds offers a better alternative to delayed primary closure.

SURGEON AND HIV INFECTION: Post Exposure Prophylaxis: Need of the hour.

HIV infection in HCW is an occupational hazard requiring policy decisions by the health care administrators. In this article we have outlined a post exposure prophylaxis protocol following HIV exposure in HCWs. By determining the HIV status code of the source and the HIV exposure code of the HCWs, recommendations for PEP are forwarded. Occupational exposures should be considered urgent medical and surgical concerns to ensure timely administration of PEP. At the end, an algorithm is provided to guide exposed health-care workers in deciding when to consider PEP.