Ruchira Das

Lichtenstein’s mesh versus Bassini tissue repair technique for obstructed inguinal hernia: a controlled randomized study

SummaryBackgroundThe purpose of the study is to evaluate the use of synthetic mesh in obstructed inguinal hernia. Synthetic mesh repairs in inguinal hernia, though gold standard in elective operation is controversial in emergency setting. With an obstructed/strangulated hernia being the usual presentation, infection is the main concern. However, recent data indicated that mesh has advantages in emergency settings also. We took up a prospective study to evaluate this.MethodsProspective randomized controlled single-blinded study with 20 patients in each group. One group had modified Bassini tissue repair and the other Lichtenstein repair with polypropylene mesh. Statistical analysis: the t-student/Fisher test and chi-square tests. Follow-up period: 2-years.ResultsOperating time and postoperative hospital stay was significantly less in mesh repair. Mesh repair showed an edge over pure tissue repair. Wound infection, seroma formation, and neuralgia were less in mesh repair with the difference in seroma formation being significant.ConclusionsTension-free hernioplasty using polypropylene mesh in adults with obstructed inguinal hernia should be preferred to conventional hernia (pure tissue) repair, especially where there is no resection anastomosis/perforation. The conclusion is limited to the analyzed patients and long-term analysis in a larger study population is indicated.

Laparoscopic Cholecystectomy in a Patient with Portal Cavernoma

Portal cavernoma (network of collateral vessels around the portal vein) is found in one-third of patients with thrombotic portal vein. Management of Cholecystitis in such a patient is problematic. Laparoscopic cholecystectomy is usually contraindicated due to risk of haemorrhage. A 32 year old female presented with symptomatic calculous cholecystitis and portal cavernoma without portal hypertension. Liver functions were normal (non-cirrhotic, no jaundice). Conservative treatment failed. Imaging assessment was by Ultrasound Doppler, followed by CT and MRCP, MRI and MRA. We performed laparoscopic cholecystectomy was successfully performed. Operative time 210 minutes, blood loss 50 ml. Extreme caution and painstakingly meticulous dissection around the cavernoma was the key to success. Although open cholecystectomy may assume to be safer in such patients; enhanced magnified vision, access and maneuverability made laparoscopy a preferred option. Standby laparoscopic and open vascular instruments facility is essential.

Health-Risk Behaviours and its Correlates among Schoolgoing Adolescents in an Urban Town of Eastern India

Default is a serious problem among tuberculosis patients who are on treatment under RNTCP, leading to persistence of infection and drug resistance in society. A multi centric retrospective observational study was under taken, to find out risk factors and reasons accountable for the default of patients registered under Category- I of RNTCP in tuberculosis unit CANTT Meerut.

Accessory lactating inguinal breast: a rare occurrence

SummaryBackgroundAccessory breast tissue can be present anywhere in the milk ridge because of incomplete involution. However, lactating accessory breast in the groin is rare.MethodsCase report.ResultsWe report a 36-year-old para 2, gravid 2, woman presenting with lactating accessory breast in the groin. She had similar symptoms during breastfeeding her first child but the symptoms subsided after she stopped breastfeeding only to recur during nursing her second child born 5 years after. Biochemical testing of the secretion confirmed it as milk. Aspiration cytology by fine needle of the swelling confirmed the breast tissue. She had no urogenital anomaly. Excision of the accessory tissue gave her relief.ConclusionsAwareness of this rare but interesting abnormality in embryological development is important. One should look for the associated abnormalities. If conservative measures fail, excision is the treatment of choice.

Jejunogastric intussusceptions@@@Jejunogastrische Intussuszeption. Bericht von 3 Fällen – Diagnose und Management: Review of three cases – diagnosis and management

ZusammenfassungGRUNDLAGEN: Jejunogastrische Intussuszeption ist selten. Wir fassten 3 Fälle zusammen, die sich während eines Monats bei uns präsentierten. Diese Studie sollte die Rolle der Sonographie in der Diagnostik und im Management (i.e. Wahl des chirurgischen Vorgehens) untersuchen. METHODIK: Fallbericht und Literaturübersicht. ERGEBNISSE: Die Patienten präsentierten sich mit Schmerzen, Bluterbrechen, Oberbauchtumor, Zustand nach Vagotomie und Gastrojejunostomie vor mehr als 10 Jahren wegen Magenulkus. Die Sonographie war in allen Fällen diagnostisch erfolgreich. SCHLUSSFOLGERUNGEN: Die Sonographie ist höchst aussagekräftig und Zeit- und Ressourcen-sparend in der Diagnose der jejunogastrischen Intussuszeption und zum Planen des Vorgehens. Dieses ist die Resektion und Fixation der Anastomose, um ein Wiederauftreten zu verhindern.SummaryBACKGROUND: Jejunogastric intussusceptions are rare. We reviewed three cases presented to us in a span of one month. This study has been conducted to assess the role of ultrasonography and to determine the type of surgery we should perform in such cases. METHODS: Case report and literature review. RESULTS: The cases presented with the classic triad of pain, hematemesis, and upper abdominal mass, with a history of vagotomy and gastrojejunostomy more than a decade ago for gastric ulcer. Ultrasonography was diagnostic in all. The diagnosis was confirmed on laparotomy. All three cases required resection anastomosis, as the bowels were already gangrenous. One case required revision surgery. CONCLUSIONS: Ultrasonography is diagnostic and can save time and resources for out of hour CT/Endoscopy. Early operation is recommended. Reduction of the intussusceptions, viability assessment and if require resection anastomosis with fixation to prevent recurrence are the standards of care.