No abstract

Background Rapid expansion in the volume and complexities of laparoscopic surgeries has been accompanied by complications, many of which can be directly attributed to abdominal access with laparoscopic trocars including visceral injury, vascular injuries, air embolism, subcutaneous emphysema, port site infections, incisional hernia and metastasis occurred post operatively. Objectives This study aimed to detect the different port site complications encountered in laparoscopic abdominal surgery in terms of incidence and management. Patients and Methods This study was conducted in the surgical operating theatre of Ain-Shams University Hospitals (Demerdash and Ain Shams University Specialized Hospital), Cairo, Egypt, from January 2018 till July 2018. Results In this study complications occurred in 37 cases out of the 400 cases (Study subjects). The incidence of port site complications in our study was 9.25%. Vessel injury occurred in 19 out of the 400 cases with incidence 4.75%. Port site infection occurred in 11 out of the 400 cases with incidence 2.75%. Visceral injury occurred in 4 out of the 400 cases with incidence 1%. Port site hernia occurred in 3 out of the 400 case with incidence 0.75%. Conclusion Study incorporated 400 subjects operated for different indications laparoscopically and patients developing any kind of complications were recorded and analyzed. The results showed 3(0.75%) port site hernias, 11(2.75%) port site infections,19 (4.75%) vessel injury, 4 (1%) visceral injury and no port site metastasis was detected.

Background Ventral hernia repair can be challenging, particularly in patients with serious comorbidity. Perforator preserving anterior component separation (ACS) by transverse skin incisions for external oblique aponeurosis release preserves both the rectus abdominis myocutaneous perforator vessels that supply the overlying skin and the connection between the subcutaneous fat and anterior rectus sheath, thereby reducing subcutaneous dead space and potentially improving overlying skin flap vascularity. Also posterior component separation via transversus abdominis release (TAR) provides effective fascial advancement while reducing wound morbidity during abdominal wall reconstructions. Both techniques give better results than classic ACS. Objectives to evaluate postoperative morbidity and recurrence rate when using transversus abdominis release technique in management of large midline incisional hernia in comparison with open perforator preserving anterior component separation. Patients and Methods the present study is a prospective study that was conducted at Ain Shams University Hospitals in Egypt, between October 2016 and October 2018. It included sixty (60) patients with large midline incisional hernia divided into two groups. First group include thirty patients who underwent transversus abdominis release with retromuscular polyprolene mesh placement. Second group include also thirty patients that underwent open perforator preserving anterior component separation and also with retromuscular placement of polyprolene mesh. Patients compared as regards operative time, length of hospital stay, postoperative pain, postoperative ileus, postoperative wound complications, rate of recurrence. Results Patients in both groups were similar with respect to age, the patients ages ranged from 20 to 70 years, with mean age in both groups around 46 years and between 20-23% have DM in each group. Perforator preserving technique has less operative time by about 40 minutes when compared with TAR technique. The postoperative pain assessment at 48hrs postoperative show that the mean pain score for TAR was (6.77 ± 1.70) and for perforator preserving group (5.47 ± 1.85). We also found that the mean hospital stay was slightly higher when performing TAR technique (5.2days) while it was (4.3days) after perforator preserving approach. There is nearly equal incidence of postoperative wound complications and also no statistically significant different rate of recurrence between two methods Conclusion both TAR and perforator preserving technique are effective and reliable method in experienced hands and if there is no special indication to one of them, the choice between both should depend on surgeon preference and experience.