Invagination and excision of the hernia sac do not have adverse effects on repair integrity. They limit the dissection and reduce the morbidity and risk of injury to the spermatic cord and surrounded structures. They are safer and more appropriate for repair of sliding hernia. Ligation of the hernia sac in inguinal hernia surgery is not only unnecessary and time consuming but also leads to increased postoperative pain. Recurrence rates are statistically unaffected by not ligating the sac.

This study compares the effect of invaginating, excision of hernia sac without ligation with the traditional method of high ligation of the hernia sac on post-operative pain and recurrence.Patients and methods: This multicenter prospective randomized study included 152 patients with 167 primary indirect inguinal hernias. In group I (54 hernias) the sac was not opened and was inverted with the finger into the peritoneal cavity. In group E (56 hernias) the sac was excised at the neck without ligation. In group L (57 hernias) the sac was transfixed at the neck and excised in the traditional manner. The repair of the posterior wall of the inguinal canal was done according to Lichtenstein tension free technique. Mean length of follow up was 81.50± 22.34, 79.35 ±26.76 and 77.83±21.26 months respectively.Results: Postoperative seroma occurred in 1 patient (0.60%) in group E and 1 patient (0.60%) in group L. Surgical site infection occurred in 2 patients (1.20%) in group I, 1 patient (0.60%) in group E and 2 patients (1.20%) in group L. Mean postoperative pain score was 3.04± 2.11, 3.98± 2.33 and 4.06±2.43 respectively (p: 0.049). Chronic pain occurred in 3 patients in group I (1.80%), 3 patients in group E (1.80%) and 5 patient in group L (3.00 %) (P: 0.749). The difference between the complications in three groups was statistically insignificant (p: 0.887). Hernia recurrence occurred in 3 patients (1.80%) in group I, 1 patient (0.60%) in group E and 1 patient (0.60%) in group L (p: 0.429). Conclusion:Invagination and excision of the hernia sac do not have adverse effects on repair integrity. They limit the dissection and reduce the morbidity and risk of injury to the spermatic cord and surrounded structures. They are safer and more appropriate for repair of sliding hernia. Ligation of the hernia sac in inguinal hernia surgery is not only unnecessary and time consuming but also leads to increased postoperative pain. Recurrence rates are statistically unaffected by not ligating the sac.

This study was designed to investigate the role of palliative gastrectomy in advanced gastric adenocarcinoma patients having hepatic metastasis without extra-abdominal disease at diagnosis.Patients and methods: This study was performed in General Surgery Department, Tanta University Hospitals, Egypt on 29 patients with advanced gastric cancer having hepatic metastasis. Patients were selected with histopathologically proven gastric adenocarcinoma; presence of hepatic metastasis at the time of diagnosis; absence of extra-abdominal disease and having a performance status of 2 or less on the Eastern Cooperative Oncology Group (ECOG) scale. None had received prior chemotherapy or radiation therapy. Patients were categorized into the two groups; Group I, 8 males and 3 females underwent gastrectomy with subsequent chemotherapy. Eighteen patients in group II, 11 males and 7 females received chemotherapy alone without gastrectomy. All patients were treated with systemic 5-fluorouracil based regimens.Results: The mean follow-up time was 258±122 days. The mean survival of GI and GII patients were 397±59.7 and 173±46.8 days (p > 0.0001). The mean metastatic progressionfree survival was 329±54.7 and 141±49.4 days (p > 0.001). In 11 (38%) of 29 patients the primary tumor was removed (total gastrectomy in 7 and distal gastrectomy 4 patients). No patient underwent liver resection. Wound infection developed in one of the patients of the resection group. He were conservatively treated. One of the patients was reoperated for minor leakage from the anastomosis leading to intraabdominal collection. The mean hospital stay of the first admission for GI and GII patients was 13.9 ±6.41 and 4.28±1.41 days respectively (p>0.0001). The Hospitalization index was not different between the two groups. The Ingestion index was significantly higher in GI than in GII. Gastrectomy increased the survival of the patients regardless to their number and localization of hepatic metastasis. Related risk factors based on the univariate analysis were serum tumor marker levels (p 0.036), number of hepatic metastasis (p 0.0045), resection of primary tumor (p >0.0001) and the absence of extra hepatic spread (p 0.027). Conclusion:Despite stage IV patients have poor prognosis, removal of the intact primary tumor for gastric cancer with synchronous hepatic metastasis at diagnosis is associated with improvement in overall survival and metastatic progression-free survival.

This trial aimed to compare the feasibility of the total extraperitoneal (TEP) laparoscopic technique with the Lichtenstein hernioplasty in treating recurrent inguinal hernias. Patients and methods: This prospective randomized multicenter study included 62 patients with unilateral recurrent inguinal hernia randomly categorized into 2 groups. Group A included 32 patients operated on by TEP laparoscopic hernioplasty. They were compared to 30 patients treated by conventional Lichtenstein hernioplasty (Group B). Mean length of follow up was 82.1±14.7 months in group A and 82.9 ± 13.6 months in Group B. Results: Mean operative time was 66.2 ±11.2 minutes in group A versus 48.6 ±9.86 minutes in group B (p< .0001). First postoperative day pain score was 1.88 ±0.619 versus 2.53 ±0.743 (p0.012). Group A patients needed 2.12 ±0.719 ampoules of 100 mg Pethedine in the first postoperative day versus 3.07 ±1.62 ampoules in group B patients for analgesia (p0.044). Hospitalization time was 1.31 ±0.602 days and 1.47 ±0.990 days (p0.60). Time to return to normal activity was 13.9 ±3.77 days and 17.9±3.64 days (p0.0056). We had to convert 3 patients (4.8%) to the open repair due to lack of experience at the start of our research. In group B, Postoperative seroma occurred in 1 patient (1.6%), surgical site infection in1 patient (1.6%) and 2 patients (3.2%) suffered from chronic pain that started after operation. One patient markedly improved after 6 months while the other suffered from persistent low grade pain that failed to improve until the end of the study (p: 0.65). Hernia recurrence occurred in 1 patient (1.6%) in either groups 15 and 37 months after operation (p0.96). Patient satisfaction score was 8.25± 1.39 versus 7.33± 1.18 (p 0.058) Conclusion: Compared to open Lichtenstein hernioplasty, laparoscopic TEP approach for repair of recurrent inguinal hernia is technically feasible, safe and effective, with good clinical outcome. It is associated with longer operative time but reduced post-operative pain, analgesic requirement, and infection rate and earlier return to normal activities. The complication rate and recurrence rate were equal but patients were more satisfied.