Prophylactic mesh placement (PMP) is increasingly being used to reduce the incidence of incisional hernia after routine and emergency midline laparotomy (EML). However, such studies are not available for EMLs done solely for intestinal perforation. Patients who underwent non-absorbable PMP during EML for intestinal perforation (Group A, 15 patients) were compared with those who had a conventional abdominal wall closure (Group B, 20 patients). The incidence of wound dehiscence was significantly higher in Group A, while surgical site infection (SSI), and incisional hernia were similar in both groups. Mesh explantation was needed in half the cases. A prophylactically placed non-absorbable mesh in patients undergoing EML for intestinal perforation is associated with significantly higher rates of wound dehiscence and of mesh explantation and therefore, routine use of such a mesh appears not to be justified.

Points• Centchroman, also known as Ormeloxifene, is a relatively new drug under the class of non-steroidal selective estrogen receptor modulators which is being used to treat mastalgia. •We evaluated the beneficial effect of Ormeloxifene (Centchroman) versus a combination of Gamma Linolenic acid (GLA), methylcobalamine and vitamin C on mastalgia in a three-arm, open-label, placebo-controlled trial.• In this study Ormeloxifene was not superior to GLA or placebo and was also associated with concerning side effects.

Background & Aims: Enterostomy reversal and fascial defect cause weakness in the abdominal wall and may lead to formation of incisional hernia. Literature says that placement of synthetic mesh in dirty/contaminated wound causes high chances of surgical site infection (SSI) and mesh related complications. This dogma is now challenged. Present study was conducted to evaluate outcome of the placement of synthetic non-absorbable mesh after enterostomy closure in terms of SSI and incisional hernia. Materials & Methods:This prospective case-control study was conducted in the department of General surgery Netaji Subhash Chandra Bose (NSCB) medical college, Jabalpur, between 1 st December 2018 to 30 th September 2020. All patients of age >18 years with ileostomy/colostomy undergoing enterostomy reversal were included. Outcomes noted for wound infection/dehiscence, mesh related complications, its removal, and development of incisional hernia.Results: Total 60 patients were included in this study. Out of which, 30 (23 loop ileostomy, 5 double barrel ileostomy, and 2 colostomy) were taken as the case; where polypropylene mesh was placed (9 sublay and 21 onlay). 30 others (28 loop ileostomy, 1 double barrel ileostomy, and 1 colostomy) were taken as control where mesh was not placed after stoma closure. SSI was significantly lower in mesh placed group than non-mesh placed group (16.6% vs. 40%; P=0.019). Use of mesh was associated with slightly better outcomes but not significant in terms of rate of wound dehiscence (3.3% vs. 6.7%; Z=0.59; P=0.554) and incisional hernia (0 vs 6.7%; p= 0.492) in mesh and non-mesh groups, respectively. Mesh removal for chronic infection was not required in any case. Conclusion:Placement of permanent synthetic polypropylene mesh at the site of enter ostomy closure for prevention of incisional hernia can be done safely without fear of having increased risk of SSI and need of mesh removal.

Purpose: Many methods have been used to treat complex fistulas, but no single technique has been considered standard. Damage to the sphincter may sometimes be unavoidable, and incontinence may be an important cause of morbidity. This study aimed to validate the results of transanal opening of the intersphincteric space (TROPIS), as a technique that avoids damaging the anal sphincter, in patients with complex fistula in ano. Methods: A prospective study was conducted among 35 consecutive patients with complex fistula in ano. After a preoperative magnetic resonance fistulogram, TROPIS was performed in all patients. The St. Mark's incontinence score was assessed preoperatively and postoperatively at 3 months. Results: The tracts were intersphincteric in 16 patients, transsphincteric in 10, extrasphincteric in 2, and horseshoe in 3. Four patients had recurrent tracts (3 transsphincteric and 1 intersphincteric). A defined follow-up schedule was used. Curettage was done if postoperative pus drainage from the wound was noted. The fistula healed in 29 patients (82.86%) following TROPIS. The remaining 6 patients received curettage, with healing in 3 (overall healing rate, 91.4%). Patients who received curettage were followed for 3 months, and the outcome was labeled as healed or failed. The mean preoperative incontinence score was 0. One patient developed incontinence to gas postoperatively in week 2, but there was no significant change in the scores at 3 months postoperatively. The mean postoperative incontinence score was 0.02. Conclusion: TROPIS is an effective method for the treatment of complex fistula in ano, with minimal risk for incontinence.