IntroductionThe need of this study is to assess the role of collagen III in all hernias which include primary inguinal hernias ventral and recurrent abdominal hernias.Collagen type III represents the mechanically instable, less cross-linked collagen synthesized during the early days of wound healing. Quantitative assessment of collagen III in scar tissue on transversalis fascia as tissue obtained from cases operated for various hernias and compared to that of patients operated for abdominal surgeries for indications other than hernia was compared.Materials and methodsIn this study we had a total of 90 patients, of which 45 patients underwent mesh repair for the various hernias and 45 patients who underwent laparotomies for various reasons were included as controls. Size of 1 × 1cm transversalis fascia was taken in both subjects and was sent for quantitative assessment using Immunohistochemistry test. All the above cases were randomized as per age,sex,BMI, co morbidities and materials used for repair.ResultsResults were analysed quantitatively and classified into following groups:Based on intensity of staining into Mild, Intermediate and Well stained and based on Quantity of Collagen III into Grade 0---NIL, Grade 1--1-25%, Grade 2-26-50%, Grade 3--51-75%, Grade 4--76-100% (Table 1). In the case group we had 52.4%,35.7% and 11.9% of the cases in Grade 4, Grade 3 and Grade 2 which proved that there was increased presence of Collagen 3, where as 84.4%,4.4% and 11.1% of patients in the control group were classified as Grade 1, Grade 2, Grade 0. For the quantitative study -Chi square test value −81.279 and the p value < 0.001. For the intensity of staining -Chi square test value −57.64 and p value is < 0.001.ConclusionThis study signifies that ventral, recurrent and primary inguinal hernias are not just caused because of a primary defect but an acquired disorder with respect to collagen distribution.

A 68-year-old lady was referred to our emergency department, with evisceration of small bowel through anal canal following manual reduction of prolapsed rectum, three days ago. On careful and thorough examination, she was found to be hemodynamically stable. Abdomen was soft and did not show any features suggestive of peritonitis. About three feet of the small bowel with its mesentery was eviscerating through the anal canal which was congested, oedematous and had multiple serosal tears [Table/ Fig-1].In emergency department, the eviscerated bowel was washed copiously with warm saline and covered with moist towels. Broad spectrum antibiotics were given and IV fluids were started. Relevant preoperative work up was done and patient was posted for emergency laparotomy.A lower midline laparotomy was performed, and the eviscerated bowel was gently reduced into the peritoneal cavity with simultaneous support and guidance through the anal canal. After complete reduction of the eviscerated bowel into the peritoneal cavity, a 2x3 cms perforation was noted in the anterior wall of the middle third rectum [Table/ Fig-2]. The margin of perforation was freshened and closed with interrupted polyglactin sutures. A sigmoid loop colostomy was also performed. In view of dilated and congested small bowel with multiple serosal tears, a laparostomy was performed to observe for the integrity and viability of bowel in post-operative period.Immediate post-operative period was uneventful. After 48 hours, saline wash was given through the laparostoma, under epidural analgesia. The bowel appeared normal. However on the fourth post-operative day patient developed breathlessness, bradycardia, hypotension and desaturation with respiratory acidosis. On evaluation she was diagnosed to have acute myocardial infarction with elevated troponin-T levels. The patient was supported with ventilator and inotropes with immediate treatment of the acute myocardial infarction. Despite our prompt response and best supportive care, the patient did not recover from the cardiac insult and succumbed on the twelfth post operative day with multiple organ dysfunction. DIsCUssIoNTransanal evisceration of bowel is a rare complication of chronic prolapse of rectum. This surgical emergency occurs due to herniation of bowel through the breech in the rectal wall. This condition was first described by Brodie in 1827, since then very few cases have been reported [1]. Wrobleski DE, Dailey TH presumed that mainly two factors predispose these patients for this unusual complication. More than 75% of these cases were associated with chronic prolapse of rectum and an event of sudden increase in intra-abdominal pressure [2][3][4]. Broden B, Snellman B with cine-radiographic studies tried to correlate prolapse rectum with perforation. The primary mechanism of rectal prolapse is a sliding hernia, in which the pouch of Douglas and contained viscera form the sac. The hernial sac invaginates the anterior wall of rectum into the rectal lumen resulting in ischemia and the weakening, makin...

Background Stapled hemorrhoidopexy is widely practiced worldwide since its introduction to the world of proctology and replaced conventional hemorrhoidectomy in treating hemorrhoids. The technique of executing the procedure dictates the outcomes and complications. Here, we attempted to establish the cause of postoperative complications and attributed them to the presence of muscle of fibers in the excised doughnut specimens. Materials and Methods A prospective observational analysis of histopathological specimens obtained from patients who underwent stapled hemorrhoidopexy using procedure for prolapse and hemorrhoids-03 circular staplers in the department of surgery of a tertiary care hospital in southern India was performed, and the correlation between the presence or absence of muscle fibers in the specimens and postoperative complications was evaluated. The patients were followed up for 12 months after the procedure. Results In this study, 155 patients, including 54, 91, and 10 patients with Grade 2, Grade 3, and Grade 4 hemorrhoids, respectively, were included. Group A consisted of 19 patients with muscle fibers on the specimens, whereas Group B consisted of 139 patients without muscle fibers on the specimens. Early complications within 7 days after the procedure were as follows: 21 and 0.7% of the patients in Groups A and B, respectively, presented with postoperative pain with a visual analog scale score of more than 4; 47 and 6% of the patients in Groups A and B, respectively, presented with urinary retention; 26 and 2% of the patients in Groups A and B, respectively, presented with bleeding; and 21 and 2.9% of the patients in Groups A and B, respectively, presented with fecal urgency. A significant association was found between the presence of muscle fibers and early complications (p < 0.001). Late complications, such as proctalgia and bleeding, accounting for 36.8 and 6.6% in Groups A and B, respectively, were significantly associated with the presence of muscle fibers in histopathology (p < 0.001). Meanwhile, other late complications, such as incontinence, stenosis, and recurrence, exhibited no association (p > 0.05). Conclusion The technique in taking purse-string sutures and the depth of the suture bite above the dentate line carry the utmost importance in preventing postoperative complications. Therefore, surgeons should refine their technique of appropriate depth to avoid incorporation of muscle fibers while executing the procedure.