Objective: Evaluation of mesh associated complications and reviewing its selective application in hernia surgery. Design: Descriptive study. Setting: Department of Surgery, Fauji Foundation Hospital, Rawalpindi. Period: Jan 2019 – June 2022. Material & Methods: Patients having undergone hernia surgery in past with mesh repair at FFH or any other hospital that had developed complications and reported to surgical unit 1 FFH. Patients of hernia surgery without mesh repair were excluded. Results: A total of 50 cases were included in the study. Majority of patients were females 42(84%). Paraumbilical hernia 18(36%), Epigastric hernia 13(26%), Incisional hernia 12(24%) and Inguinal hernia 7(14%) cases were included in study. Chronic discharging sinus 16(32%), Recurrent acute local sepsis 12(24%), Large painful seroma 5(10%), Recurrent hernia 13(26%), Acute fulminant sepsis after primary surgery 2(4%) and intestinal obstruction 2(4%) were the mesh associated complications present in patients. Majority of the patient required hospitalization and delayed removal of mesh [43 cases] (86%]. Early removal of mesh was required in 2(4%) cases. The residual defect after the removal of mesh was managed by Component separation and slide method: Early in 2(4%) cases and delayed in 17(34%), double breasting of facial sheath 10(20%), double breasting of external oblique with exteriorization of cord 6(12%) cases. Wound toilet and symptomatic treatment without removal of mesh was advised in 3(6%) cases. Emergency laparotomy and gut anastomosis was performed in 2(4%) cases. Conclusion: Indiscriminate use of mesh needs to be checked, as a significant number of patients develop mesh related complications.

Objective: To assess the outcome of end to side Ileo-Ascending Colic anastomosis in patients undergoing emergency and elective Ileo-Caecal resection in non-malignant cases. Study Design: Cross Sectional Descriptive study. Setting: Department of Surgery at Fauji Foundation Hospital Rawalpindi. Period: January, 2018 to December, 2020. Material & Methods: A Total of 40 patients with ileo-caecal benign pathology presenting with generalized peritonitis and intestinal obstruction were studied. All patients underwent laparotomy either in emergency or as planned procedure. After dealing with the primary pathology an end to side ileo-ascending colic anastomosis was performed in all cases. Cases of ileo-caecal disease that required an ileostomy or underwent ileo-transverse colic anastomosis were excluded from the study. Anastomosis was performed in conventional two layers with vicryl 3/0. Variables studied were; indication for surgery, per-operative findings and post-operative complications like anastomotic leakage, surgical site infection, burst abdomen and systemic sepsis. Data was analyzed on SPSS (v 26). Results: There were 30 females (75%) and 10 male patients (25%). Age range was 18-72 years with mean age 43.62 years. Common clinical indication of surgery was intestinal obstruction 11 cases (27.5%) followed by generalized peritonitis 10 cases (25%) and trauma 9 cases (22.5%). Post-operative diagnosis in most patients was ileo-caecal tuberculosis 14 cases (35%) followed by trauma to ileo-caecal region 9 cases (22.5%). Anastomotic leakage occurred in 1 patient (2.5%) who underwent second look laparotomy and re-anastomosis. Surgical site infection occurred in 3 cases (7.5%). There was one fatality (2.5%) due to uncontrolled systemic sepsis. Conclusion: An end to side ileo- ascending colic anastomosis in conventional two layers is a safe and reliable procedure after emergency or planned ileo-caecal resection. It saves the patient from ileostomy, preserves colonic length and avoids formation of blind loop.