Keywords : ABDOMINAL
Basrah Journal of Surgery,
2017, Volume 23, Issue 1, Pages 14-17
MODIFIED SHOELACE REPAIR OF LARGE ABDOMINAL INCISIONAL HERNIAS
Ali Abdul-Aziz Al-Shawi
MB,ChB, FICMS, CABS, Department of Surgery, College of Medicine, Chancellor Missan University, Missan, IRAQ.
This study aimed to evaluate modified shoelace darn repair. An abdominal incisional hernia represent defect in the musculo-fascial layers of the abdominal wall. It considers one of the commonest hernia in middle aged women. surgical site wound infection is the most common causative factor and there are different method of surgical repair.
This prospective study was conducted on 127 patients of incisional hernia who were managed by modified shoelace darn procedure, they had reinforce the repair by onlay mesh to bridge the defect in anterior rectus sheath.
The highest proportion of patients aged 41-50 years (37% with a mean of 43.6 years). Regarding distribution of gender, the pattern was similar in both sexes. Most of the patients were overweight (76.4%). Further 14.9% were obese and only 7.9% were normal, 29.9% developed some kind of complication. The recurrence rate was 1.6%.
In conclusion, modified shoelace darn repair is simple, safe, extra-peritoneal with less tissue damage and it seems a good surgical technique for management of large ventral incisional hernia.
Basrah Journal of Surgery,
2005, Volume 11, Issue 1, Pages 20-31
Pregnancy is the only physiologic condition that is treated in the hospital environment. All other medical conditions that are treated in such a setting are pathologic. When a pregnant patient develops a pathologic condition that requires surgical intervention, it is imperative to remember that the lives of two individuals are involved, the mother and the foetus. In such settings it is essential that the treating surgeon understand the physiologic states of these two individuals as an interdependent symbiotic relationship. Not only must appropriate maternal care be rendered, prevention of foetal complications is also desirable.
Changing physiology and anatomical landmarks frequently cause confusion and delay in dealing with surgical problems in the pregnant patient. Both symptoms and signs could be modified, contributing to delay in seeking medical attention, timely referral for surgical evaluation, or the initiation of appropriate diagnostic procedures.
Surgery during pregnancy is an uncommon event, but one that creates a great deal of anxiety for both patients and medical practitioners. Delays in diagnosis and definitive treatment represent the most significant risk for untoward outcome in both the mother and the foetus.
Laparoscopic surgery has rapidly and widely spread in the management of wide abdominal conditions, which resulted in several significant benefits to the non-gravid patients. Pregnant patients and their foetuses could drive the same benefits from minimally invasive surgery, which are received by the non-gravidas. However, due to the several physiological and anatomical factors encountered during pregnancy many issues need to be thought about and dealt with.
Optimal surgical treatment of the pregnant patient will be realized when there is collaboration between the various subspecialties involved in her care.