No abstract

No abstract

An 82-year-old male presented to the emergency with complaints of abdominal distention, nausea and vomiting since the past 3 days. It was also associated with pain in the abdomen which was diffuse in nature, non-radiating with no aggravating or relieving factors. Patient gives history of decreased passage of stool and flatus since the past 2 days. Patient gives history of smoking since the past 30 years. Patient had past medical history of coronary artery disease (post-angioplasty), CKD (Chronic Kidney Disease), Hypertension and COPD (Chronic Obstructive Pulmonary Disease). Patient had a history of old Pulmonary TB for which he had undergone treatment. On admission, patient was conscious, oriented, in a state of shock with BP-80/60 mmHg on noradrenaline support of 5 ml/hr, Pulse rate-120 beats per minute (ECG was done which showed Atrial Fibrillation with fast ventricular rate), afebrile. Chest-bilateral air entry was present with occasional ronchi, CVS-S1S2 present, P/Adistended with guarding, diffuse tenderness and absent bowel sounds. 2D Echo showed global hypokinesia with ejection fraction-50%. Initial resuscitation was done, and patient was optimized. Due to unstable condition of the patient and lack of improvement after initial supportive therapy patient was planned for emergency laparotomy.

Background: Minimally invasive inguinal hernia surgery originated in the early 1990s and is gaining popularity in the field of general surgery. A mesh provides a tension-free repair with strengthening of the abdominal wall. This study was undertaken to compare traditional polypropylene and lightweight meshes in TEP inguinal hernioplasty in terms of post-operative patient reported outcomes.Methods: A total of 65 patients were enrolled in the study. Patients were divided into 3 groups i.e. Polypropylene (21), TiMesh-16 (24) and Ultrapro (20) based on mesh used. Assessment of pain was done using visual analogue scale (VAS). Patient reported outcomes were observed on 1st post-operative day (POD), 7th day, 1 month, 6 months and 1 year. Data was analysed using SPSS software ver.22.Results: A total of 94 hernias were operated in 65 patients. Mean operative time in both unilateral and bilateral cases was not significant and showed no correlation with type of mesh used. Mean VAS score of prolene group was significantly more than Ultrapro and TiMesh groups on POD1, POD7, 1 month and 6 months, showing p=0.027 (POD1), p=0.002 (POD7), p=0.017 (1 month) and p=0.00 (6 months) respectively. Patients in LWM groups showed earlier return to activities than Prolene group. No recurrence was observed in either group on 1 year follow-up. Among the study patients, complications of TEP observed were accidental rupture of peritoneum, scrotal swelling, seroma, sub-cutaneous emphysema and conversion to lichtenstein mesh hernioplasty.Conclusions: As per the observations, Light weight mesh placement in TEP Hernioplasty results in better patient reported outcomes.