External Oblique Aponeurosis Research Articles

Is There a Direct Effect Between the Plication of the Myoaponeurotic Layer and the Force of Inspiratory and Expiratory Muscles After Abdominoplasty?

Abdominoplasty may generate an increase in the intra-abdominal pressure (IAP) and consequently an alteration in the pulmonary ventilation. The purpose of this study was to evaluate the potential alterations in the maximal static inspiratory pressure (MIP) and maximal static expiratory pressure (MEP) after abdominoplasty. Thirty-three female patients, aged between 18 and 60, with type III/B Nahas abdominal deformity that underwent abdominoplasty with plication of the anterior rectus and external oblique aponeurosis were selected. The MIP and MEP were measured using a mouthpiece. This is a simple way to indirectly gauge inspiratory and expiratory muscle strength. Measurements were performed before surgery and on the 2nd, 7th, 15th, and 180th postoperative day. In addition, IAP was measured before abdominoplasty and after the placement of compression garment. The MIP and MEP were compared using analysis of variance, followed by the Bonferroni multiple comparison test pairing the different points in time. Paired Student's t test was used for comparing IAP measurements. Pearson's correlation test was used to compare MIP and MEP variations with IAP variation. Results were considered statistically significant when P ≤ 0.05. A decrease was observed in MEP on the 2nd day, with a return close to normal values on the 15th day. In opposition MIP had a surprisingly increase on the 15th postoperative day (129 cmH2O), normalizing 180 days after the operation. A leap in IAP values was revealed at the end of the surgical procedure. It was not possible to establish a positive correlation between the increase of IAP and the alterations of MIP and MEP. There is a decrease in maximum expiratory pressure on the very early postoperative day (2nd postoperative day) and an increase in maximum inspiratory pressure on the 15th postoperative day in patients who underwent abdominoplasty. There was no correlation between the IAP and maximum respiratory pressure variations, both inspiratory and expiratory.

Reconstruction of the extensor tendon on the dorsal pedis with a chimeric skin-aponeurosis flap from the groin region

BackgroundComplex defects involving the extensor tendon on the dorsal pedis have been reconstructed using multiple procedures. Skin coverage and tendon transfers have also been performed. This study aimed to present our experience using a chimeric skin-aponeurosis flap for one-stage reconstruction of composite soft-tissue defects on the dorsal pedis. MethodsBetween May 2017 and September 2020, 12 patients with these defects received total treatment using a chimeric groin flap. Based on the superficial circumflex iliac vessels, the skin paddle resurfaced the cutaneous defect, and the vascularised external oblique aponeurosis was rolled to form a tendon-like structure to simultaneously replace the absent segment of the extensor tendons. A suitable “Y” bifurcation was dissected to enlarge the vessel diameter. Single-stage reconstruction was performed using a set of vascular anastomoses at the recipient site. ResultsFlap survival was achieved without significant complications. The hammertoe deformity was completely removed. The average dimension of the skin paddle was 8.0 × 13.0 cm (range, 6.5 × 11.0–10.0 × 14.0 cm), and the mean size of the aponeurosis was 8.0 × 4.0 cm (range, 6.0 × 3.0–10.0 × 5.0 cm). At the last follow-up visit, no morbidity was observed at the donor site. Natural shapes and walking functions were successfully achieved with a protective sensation. ConclusionThe chimeric groin flap with sheets of external oblique aponeurosis is a great candidate for one-stage reconstruction of composite soft tissue loss on the dorsal pedis. This approach provides cosmetic coverage, allowing faster wound healing and reduced tendon adhesions.

HERNIA MESH EXPLANTATION FOR MESH INGUINODYNIA AND ALLODYNIA. WHY IS HERNIA MESH SO PAINFUL?

Abstract Introduction Chronic pain after mesh repair for abdominal wall hernia is an indication for the removal of mesh and reconstruction by a non-mesh technique. Materials and Methods In a consecutive series over 19 years, 128 patients had mesh removed to relieve chronic pain. This open method of mesh removal relies on confirming normal anatomical landmarks. The superior and inferior leaf of the External oblique aponeurosis are raised, the spermatic cord is identified and retracted. The mesh is gently dissected off the Internal oblique from lateral to medial, taking care in preserving the vas, and accompanying vessels. Adherent ilio-inguinal, iliohypogastric and genitofemoral nerves are removed with the mesh. The resultant recurrent hernia is repaired by Moloney darn, a tension-free tissue repair. Results 128 consecutive patients have been treated by mesh explantation and immediate reconstruction on average 6 years after implantation. Resolution of symptoms was experienced very shortly after the mesh removed. Preperitoneal mesh particularly Kugel patch has been the most difficult to remove. Meshes have been submitted for histological examination and the findings are usually chronic granulomatous foreign body reaction. Few complications have been encountered with a follow-up period ranging from 6 months to 15 years, the most common being the failure of explantation to alleviate inguinal pain in the long-term. Conclusion All hernia patients should be afforded informed consent including discussing the potential long-term consequences of chronic groin and abdominal pain.

Comparative Study of Collagen Density, Fibroblast, and Neovascularization in Tracheal Defect Reconstruction with Primary Repair and External Oblique Muscle Aponeurosis Patch (A Novel Study with New Zealand Rabbit)

Background: The lack of ideal materials and the high incidence of complications make tracheal defect reconstruction challenging. The use of aponeurosis as a surgical patch and flap in reconstruction is not uncommon, but no studies had been conducted to analyse its use in tracheal defect reconstruction, though its effectivity in wound healing was significant in reconstruction of other organs. Objective: This study aims to compare collagen density, fibroblast expression, and neovascularization in tracheal defect reconstruction using primary suture and using external oblique muscle aponeurosis patch. Methods: This randomized control trial is a laboratory experimental study using male New Zealand white rabbits. Randomization was carried out with permuted block randomization into a control group (primary suture) and a treatment group (reconstruction with external oblique muscle aponeurosis patch). Mascroscopic and histopathological assessments were carried out 14 days after surgery. Results: We got homogeneous samples in both groups (9 samples each) in terms of age (p = 0.763), weight before procedure (p = 0.347), and weight after procedure (p = 0.536). Macroscopically, no wound dehiscence, pus, or inflammation at the surgical site in either the control or treatment groups. Histopathological analysis showed that there were no differences in collagen density (p = 1.00), fibroblast expression (p = 0.414), and neovascularization (p = 0.558) between the two groups. Conclusion: It can be concluded that there are no differences in collagen density, fibroblast expression, and neovascularization in New Zealand rabbits with tracheal defect using primary suture and using external oblique muscle aponeurosis patch

Incarcerated infraumbilical incisional hernia: a surgical challenge

Incisional hernia continues to be the most challenging type of hernia. Variability in the anatomy and supervening complications add to its complexity. Infraumbilical incisional hernias are usually due to gynecological operations. This may range from a scar of tubal ligation procedure to a Pfannenstiel incision or an infraumbilical scar of caesarian section. The sparse volume of strong anatomical structures in this region poses the biggest challenge during repair. A 54-year-old lady presented with a hernia arising from a scar of previous tubal ligation surgery. The hernia was irreducible with a large mass of omentum in the hernial sac. Laparoscopy was difficult to perform in view of the current state. Hence open surgery was performed. The technique used was creation of a preperitoneal space followed by creation of space between external oblique aponeurosis and underlying muscle. A mesh as placed between the muscular and aponeurotic layer. The post-operative course was uneventful with no recurrence. The anatomical basis of placing the mesh between the muscular and aponeurotic layer or intermediate placement technique is discussed. Creation of space below the aponeurotic level is pivotal in managing infraumbilical incisional hernia. Placing a mesh at this layer below the aponeurosis ensures least complications with excellent result.

An X across the Chest: A Rare Case of a Criss-crossed Sternalis Muscle.

The present case study aims at drawing attention to a very rare presentation of the sternalis muscle noticed during routine dissection, and is intended to highlight the clinical significance and usefulness of this unique muscle in reconstructive surgeries, especially of the breast. Though many morphological variants of the muscle have been reported, we came across a unique bilateral sternalis muscle during routine dissection for undergraduate medical teaching, in an 80-year-old male cadaver. The muscle originates on both sides from the external oblique aponeurosis from the fleshy belly, and after becom-ing tendinous, converges in the midline to form a common tendon at the level of the sternal angle, and then splits again into two tendons which become continuous with the ipsilateral sternocleidomastoid. Notwithstanding the fact that the presence of a sternalis can be misdiagnosed as a wide range of anterior chest wall lesions and tumors, especially with misdiag-nosis of breast masses in routine mammograms, it has great use as a muscular flap for reconstructive surgeries of the anterior chest wall, head, neck and breast.

A Case of Open Zone Ⅰ Extensor Tendon Rupture Reconstructed by External Oblique Muscle Aponeurosis with Perifascial Areolar Tissue

A Case of Open Zone Ⅰ Extensor Tendon Rupture Reconstructed by External Oblique Muscle Aponeurosis with Perifascial Areolar Tissue

Sternalis Muscle Profile: A Cadaveric Study

Background: Sternalis muscle is an additional muscle of anterior chest wall present in the superficial plane occasionally. It can be unilateral or bilateral. It is attached below to ribs or costal cartilages and above to the upper part of sternum. Its fibres may fuse with pectoralis major, sternocleidomastoid muscle or external oblique aponeurosis. Purpose of study: To study the profile of sternalis muscle in cadavers. Material and methods: During a time period of ten years, 50 adult cadavers were dissected in the dissection hall of Anatomy department of Maharaja Agrasen Medical College, Agroha. During the dissection of anterior chest wall a bilateral strap like muscle was found in one male cadaver. Morphometry of this muscle was done. The nature of muscle fibres, length, distance from the midline and angle with the midline was measured. Results: Bilateral sternalis muscle was found in one male cadaver. It was extending from the fifth rib 3 cm lateral to the lateral border of sternum to the sternal angle on both the sides. Lower part of the muscle was fleshy while its upper part was tendinous. On the right side, its tendon was bifurcating into medial and lateral lamina in the upper part of the muscle. The fleshy part of the muscle was 8 cm, medial lamina 4.5 cm and lateral lamina was 3 cm in length. On the left side, muscle was 13 cm in length with a single tendon. Conclusion: The early detection is essential in regular mammogram screening to differentiate it from the malignant lesions. This muscle is a matter of interest for anatomists, radiologists and surgeons for doing surgeries on anterior chest wall. KEYWORDS: Mammography, lamina, Pectoralis major muscle, Sternalis muscle, Sternocleidomastoid muscle, Sternum.

Significant relationship between musculoaponeurotic attachment of the abdominal and thigh adductor muscles to the pubis: implications for the diagnosis of groin pain.

Groin pain is prevalent in orthopedic and sports medicine, causing reduced mobility and limiting sports activity. To effectively manage groin pain, understanding the detailed anatomy of supporting muscles is crucial. This study aimed to investigate the musculoaponeurotic attachments on the pubis and the relationship among intramuscular aponeuroses of abdominal and thigh adductor musculatures. Macroscopic analyses were performed in 10 pelvic halves. The bone morphology of the pubis was assessed in two pelvic halves using microcomputed tomography. Histological investigations were conducted in two pelvic halves. The external oblique aponeurosis extended to the adductor longus aponeurosis, forming conjoined aponeurosis, which attached to a small impression distal to the pubic crest. The gracilis aponeurosis merges with the adductor brevis aponeurosis and is attached to the proximal part of the inferior pubic ramus. The rectus abdominis and pyramidalis aponeuroses were attached to the pubic crest and intermingled with the gracilis-adductor brevis aponeurosis, forming bilateral conjoined aponeurosis, which attached to a broad area covering the anteroinferior surface of the pubis. Histologically, these two areas of conjoined aponeuroses were attached to the pubis via the fibrocartilage enthesis. Microcomputed tomography revealed two distinctive bone morphologies, a small impression and an elongated osseous prominence on pubis, corresponded to the two areas of conjoined aponeuroses. This study demonstrated close relationships between the aponeurotic attachment of the external oblique and adductor longus, and between the rectus abdominis, pyramidalis, gracilis, and adductor brevis. The findings of aponeurotic complexes would aid in diagnostic and surgical approaches for athletic groin pain.

Evaluation of Desarda technique in inguinal hernia repair

Background: Mesh repair for inguinal hernia is the most commonly carried out procedure spherical the world. In recent years inguinal hernia surgery has gone through numerous advances. Desarda technique offers a new thought of hernia repair based on physiological principle that uses an undetached strip of external oblique aponeurosis which gives a complete understanding about basic aetiopathology of inguinal hernia. The aim of this study was to evaluate inguinal hernia repair by Desarda technique. Methods: This observational study was carried out at the department of surgery, Mugda medical college hospital included 50 male patients with uncomplicated inguinal hernia during August 2019 to July 2021. Data was collected by researcher himself with using a prepared structured questionnaires & checklist and analyzed on statistical packages for social science (SPSS) 24. Results: Among 50 male patients 60% belong to low-income status, mean age was 44.09±10.93 years. The mean operative time was 46.31±12.27 mins. In the first postoperative day 22 patients reported mild pain and on third postoperative day majority (42) reported no pain. The mean duration of hospital stay was 18.16±11.24 hours. No severe postoperative complication, one recurrence was reported. The mean time of return to basic activities 2.3±1.33 days. Conclusions: The results of inguinal hernia treatment with the Desarda technique are similar to the results after standard Lichtenstein operations. Patients after Desarda's operative procedure get ambulatory sooner as compared to the standard Lichtenstein mesh repair. Less Postoperative pain, complications similar to standardized technique.

Outcome of Uncomplicated Inguinal Hernia Repair by Desarda Technique in Adult Male as a Day Case Surgery at Mugda Medical College Hospital

Background: Mesh repair (Lichtenstein and Laparoscopic) for inguinal hernia is the most frequently performed operation round the world. In recent years inguinal hernia surgery has undergone numerous advances. Among them, Desarda technique provides a new concept of hernia repair based on physiological principle using an undetached strip of external oblique aponeurosis. Worldwide, day case inguinal hernia surgery has been markedly increased irrespective of technique. Due to benefit of cost effectiveness and freeing of mesh related complication, Desarda technique needs to be considered as day case hernia surgery. Objectives: To evaluate outcome of day case inguinal hernia surgery in terms of immediate and early postoperative complications, rate and reasons of unanticipated admission after surgery, time of return to basic activities and recurrence rate in our setup. Methods: This observational study was carried out at the department of surgery, Mugda Medical College Hospital included 50 male patients with uncomplicated inguinal hernia during August 2019 to July 2021. Data was collected by researcher himself with using a prepared structured questionnaires & checklist and analyzed on Statistical Packages for Social Science (SPSS) 22. Results: Among 50 male patients 60% belong to low-income status, mean age was 44.09 ±10.93 years. The mean operative time was 46.31 ±12.27 mins. In the first postoperative day 22 patients reported mild pain and on third postoperative day majority (42) reported no pain. The mean duration of hospital stay was 18.16 ±11.24 hours and only 6 (12%) patients needed unanticipated admission. No severe postoperative complication, one recurrence has been reported. The mean time of return to basic activities 2.3 ±1.33 days. Conclusion: The results of the present study demonstrate that Desarda technique can be safely offered as day case hernia surgery in our country. Further study is needed for better outcome.

Abdominal wall defect repair with component separation technique for giant omphalocele with previous relaxing incisions on the abdominal skin

BackgroundThe repair of large abdominal wall defects that cannot be closed primarily is quite challenging. The component separation technique (CST) is a surgical approach using autologous tissue to close large abdominal wall defects. The CST requires extensive dissection between the abdominal skin and the anterior sheath of the rectus abdominis muscle. Subsequently, incisions are made at both sides of the external oblique aponeurosis, releasing the external oblique muscle from the internal oblique muscle, and then the right and left rectus abdominis muscles are brought together in the midline for defect closure. However, impairment of blood flow in the abdominal wall skin and necrotic changes are recognized as potential complications.Case presentationThe CST was performed in a 4-year-old boy with a large ventral hernia who had undergone skin closure with abdominal wall relaxing incisions for the primary treatment of giant omphalocele in the neonatal period. Given his history of incisions on the abdominal wall, he was speculated to be at high risk for postoperative skin ischemia. Dissection was therefore kept to a minimum to preserve the blood supply from the superior and inferior epigastric arteries and perforating branches of those arteries through the rectus abdominis muscle. In addition, care was taken to adjust the muscle relaxant dosage while monitoring the intravesical pressure, ensuring that it did not exceed 20 mmHg to avoid impaired circulation in the abdominal wall caused by abdominal compartment syndrome. He was discharged 23 days after the surgery without any complications, and neither recurrence of the ventral hernia nor bowel obstruction was observed in 4 years.ConclusionsA giant omphalocele with primary skin closure was treated by applying the CST. The procedure can be performed safely while preserving the blood flow to the abdominal wall, even in patients with a history of relaxing incisions on the abdominal skin. The CST is expected to be effective for repairing the large abdominal wall defects seen in giant omphalocele when primary closure is not possible.

A COMPARATIVE STUDY OF LICHTENSTEIN MESH REPAIR VS NON MESH TISSUE REPAIR DESARDAS TECHNIQUE FOR INGUINAL HERNIA REPAIR

Introduction: Inguinal hernia is one of the most common problems encountered in surgery OPD with the necessity of surgicaloperationinutmost cases[1], multitudinous procedures have been proposed for inguinal hernia surgery like Bassinis, Shouldice and other tissue repair techniques. Now generally used procedure is Lichtenstein tension-free mesh technique[2]. Desardasmethod is tissue-related procedure of herniasurgery using an undetached strip of external oblique aponeurosis to strengthen the posterior wall of the inguinalcanal. This study deals with the comparison ofthe Lichtenstein technique and Desardas technique for uncomplicated inguinal hernia[9,10,11]. Aim: To find the Effectiveness of Non-Mesh tissue technique(Desarda) in comparison with mesh technique(Lichtenstein) Settings and Design: Prospective study. Materials and methods: All cases with age ranging from 21 years to 60 years with uncomplicated inguinal hernia admitted to the Department of General Surgery of our institute, between August- 2021 and July- 2022 were included. Results: It was observed that there was no significant difference in the rate of recurrence, inguinodynia between Lichtensteins technique and Desardas technique of inguinal hernia surgery. The mean duration of stay in hospital and mean duration return to normal activities was more in cases who underwent surgery by Lichtensteins technique. Complications like surgical site infection, seroma, haematomaandpost-operative pain on 1st, 3rd and 5th day were more in cases who underwent surgery by Lichtenstein technique than compared to Desardas technique. Conclusion:Desardas no mesh technique was observed with similar results to Lichtensteins mesh technique in terms of recurrence of hernia and post-operative morbidity. Desardas group showed improved results when compared to Lichtenstein group in terms of immediate postoperative pain, inguinodynia, surgical site infections, hospital stay duration and the time taken to return to normal life activities. Desardas no mesh procedure may be considered as a substitute to Lichtensteinsmesh repair to avoid long-term meshrelated morbidity for uncomplicated inguinal hernias.

Impact of combined component separation technique and shoelace repair on big medline abdominal wall defect

BackgroundClosure of large anterior abdominal wall defects, regardless of their etiology, is challenging. There is no standardized information describing definitive management. Therefore, we conducted this study to illustrate our experience on large midline abdominal wall defect repair using an effective modified reconstructive technique. MethodsThis retrospective study was conducted at Al Naqib Hospital in Aden/Yemen between 2012 and 2019. Twenty-six patients with large midline abdominal wall defects of various etiologies underwent surgical repair using a combination of shoelace repair and the component separation technique. The procedure involved bilateral longitudinal division of the anterior rectus sheet and creation of a posterior layer by approximation of the medial edges of the divided rectus sheet (shoelace abdominoplasty) and anterior external oblique muscle aponeurosis separation (component separation technique) to approximate the lateral edges of the divided rectus sheet and move the rectus muscles toward the midline for constructing the anterior abdominal wall layer. The posterior and anterior layers and bilateral separated sheets were covered with a polypropylene mesh in all patients, except in those who underwent emergency damage control surgery. ResultsFour, one, and two patients developed seroma, skin necrosis and chronic pain, and post-surgical wound infection, respectively. No recurrent herniation was recorded during the median follow-up of 5 years. ConclusionThis technique is effective in restoring the integrity of the abdominal wall in large midline abdominal wall defects and has an acceptable aesthetic appearance. In our study, minimal complications were reported, and no cases of recurrent hernias were diagnosed during follow-up.

A Patient with Crohn’s Disease Presenting with a Picture Mimicking a Strangulated Incisional Hernia: A Case Report

Objective: To report a case of Crohn’s disease that presented with a clinical picture mimicking a strangulated incisional hernia. Case Report: A 33-year-old Saudi male patient presented to the Emergency Department (ED) with vomiting, pain, and swelling at the right iliac fossa after lifting heavyweight objects two days earlier. The patient had a past history of appendectomy through a transverse incision nine years earlier. Clinically, the patient was vitally stable. He had tenderness at the right iliac fossa, and rebound tenderness. A tender swelling (6 x 8 cm) was observed underneath the previous scar. It was firm, not expansile on cough, and not reducible, with no redness or skin changes. The laboratory report showed normal results for complete blood count, apart from slight leukocytosis. Blood electrolyte levels, renal and liver function tests were normal. Plain CT abdomen showed a defect in the transversus abdominis muscle with the presence of swelling beneath the oblique muscles associated with air, which were connected to the bowel. The preliminary diagnosis was a “strangulated incisional hernia”. After laparotomy, the swelling showed pus within the external oblique aponeurosis, with a fistula tract connected to the ileum. After abdominal exploration, the inflammation was observed to be limited to the ileum and cecum with no other abnormality noted. Ileocecectomy was done with side-to-side anastomosis between the ileum and ascending colon. The resected part was sent for histopathology, which confirmed the characteristics of Crohn’s disease. Conclusions: The diagnosis of Crohn’s disease remains challenging. Its management is multi-disciplinary. Surgical management is dependent on disease location and severity. It seems that early surgery is gradually going to play a more important role in the multidisciplinary management of Crohn’s disease, rather than being a last-resort therapy. Key Words: Crohn’s disease, Diagnosis, Surgical management, Case Report.

Evaluation of continuous wound infusion with local analgesics in postoperative renal transplantation patients: A retrospective study.

The objective is to evaluate the efficacy of the continuous wound infusion (CWI) with Ropivacaine (naropeine 2 mg/ml) on postoperative pain, analgesics consumption, and bowel function in renal transplantation patients. A retrospective study trial including 79 patients who underwent renal transplantation. Patients were separated into two groups (catheter or without catheter). We identified 52 (65.8%) patients who received catheter wound infusion during the first 48 h postoperatively. On the other hand, 27 (34.1%) patients received standard without catheter anesthetic technique. Catheter wound infusion was achieved through a 12 cm catheter, inserted subcutaneously after abdominal closure. The catheter was placed above the external oblique aponeurosis. All postoperative data were examined to evaluate the first postoperative 48 h. This study aims to assess three variables: postoperative pain analysis through a visual analog scale, analgesics consumption, and bowel function. The overall score of the three variables was studied. Regarding pain assessment, we have determined that the group of patients with catheter scored better than patients without catheter with borderline significance (66.3 vs. 61.2 consecutively; P = 0.0843). An early bowel function was noted in patients with catheters on the 2nd postoperative day (P = 0.0209). Moreover, patients without catheter consumed more painkillers with nonsignificant difference (P = 0.2499). Patients with catheter showed earlier bowel function than the noncatheter group on the 2nd postoperative day. The catheter group had better pain evaluation.

DESARDA'S VS LICHTENSTEIN'S TECHNIQUE IN INGUINAL HERNIA REPAIR : A COMPARATIVE STUDY

Background: About 75% of abdominal wall hernias are inguinal hernias, with a lifetime risk of 27% in men and 3% in women. Lichtenstein's hernia repair was favored and became the gold standard of open tension-free hernia repair. However, the use of synthetic prostheses can result in new clinical problems. In order to reduce the incidence of complications and postoperative dysfunction, the tissue-based groin herniorrhaphies has re-attracted the attentions in recent years. In 2001, Dr. Mohan Desarda proposed a solution which involves use of a strip of external oblique aponeurosis to strengthen the posterior wall of the inguinal canal.(1) To compare the Aim: post-operative complications, short-term outcomes and recurrence rate for one year between Lichtenstein's and Desarda's technique. Materials And Methods: This is a prospective, randomised study (ODD – EVEN basis) in GSVM Medical College, LLR & Associated Hospitals, Kanpur (UP). 100 patients in two groups with 50 patients in each group: Group A (Lichtenstein's repair) and Group B (Desarda's repair). Outcomes were assessed on the basis of recurrence (with regular follow ups at one month, three months, six months and one year); Operating time; Cost of procedure in total; Post operative course (post operative pain, induration, redness of operated site, post operative wound infection rate. discharge time or hospital stay). Out of 100 patients majority of Results: patients were having right sided indirect hernia. The duration of the surgery was statistically less in Desarda group (53.68±20.21) than Lichtenstein (68.4±53.68) (p<0.05). The pain was signicantly lesser in Desarda group than Lichtenstein groups (p<0.05). The duration of hospital stay was signicantly lower in Desarda group (p<0.05). Seroma Formation was major complication in Lichtenstein group followed by Hematoma Formation, Surgical site infection and recurrence whereas in Desarda group seroma formation was found in only 2 patients and recurrence was in only 1 patient (association of complications in both groups was found to be statistically signicant (p<0.05)). The result of the Conclusion: inguinal hernia treatment with Desarda technique are comparable to results of Lichtenstein surgery. Desarda technique do not use mesh, this makes Desarda repair cost effective and easy to learn. Patients after Desarda's procedure get sooner ambulatory than Lichtenstein mesh repair.(2,3). Recurrence rate is more in Lichtenstein's group although the association was insignicant.(3,4). Hence, Desarda's no mesh repair is favorably comparable with Lichtenstein's mesh repair.

ОПЫТ ОРГАНИЗАЦИИ И РЕЗУЛЬТАТЫ ОКАЗАНИЯ НЕОТЛОЖНОЙ ХИРУРГИЧЕСКОЙ ПОМОЩИ В Г. СИМФЕРОПОЛЬ В ПЕРИОД ПАНДЕМИИ COVID-19

Despite of numerous publications, concerning problems of herniology, those that are dedicated to the treatment of hernia after conventional appendectomy are few. Reports about interparietal hernias can be reputed as casuistry. The aim of our study was a research of features of clinical course of interparietal hernias after appendectomy, their structure and optimization of surgical treatment. 11 patients with interparietal hernia were included among them 3 had subaponeurotic hernia, 8 – double-level. Men were 4 patients, women – 7, middle-sized hernia occurred in 5, large in 4, giant in 2 cases. According to EHS classification hernias were L1-2- 3W1L1R0 – 2, L2-3W2L1R0 – 1, L2-3W2L2R0 – 6, L3W1L1R0 – 2. The examination was routine, and in doubtful cases included ultrasound. During the examination the features of clinical picture were revealed: - 6 patients didn`t have complaints on tumor like mass, palpation didn`t show exact size of hernia and a hernia ring. Ultrasound gave information about size of hernia ring and reducibility. The type of surgery depended on the size of hernia ring, if they didn`t exceeded 5 cm there was used autoplasty, if so – alloplasty. It was shown: that features of clinical picture were lack of complaints on tumor like mass, inability to determine the size of hernia and it`s ring. Feature of structure of such hernia is that the size of intermuscular hernia sac is much bigger than the subcutaneous one. It can confuse during surgery and lead to clothing of hernia defect only in external oblique aponeurosis, leaving a problem uncorrected.

Open inguinal hernia repair Comparative study between external oblique aponeurosis flab herniorrhaphy versus lichtenstein tension free hernioplasty

Open inguinal hernia repair Comparative study between external oblique aponeurosis flab herniorrhaphy versus lichtenstein tension free hernioplasty

Inguinal single-port approach of endoscopic component separation for abdominal wall defects: A case series.

BackgroundThe component separation (CS) technique is widely used for abdominal wall defects, particularly in infected wounds. CS is associated with many wound complications due to subcutaneous blood flow disturbance. Endoscopic component separation (ECS) has fewer wound complications compared to CS and has been performed recently. However, there are various port required placements for ECS, and this technique requires proficiency. One approach for ECS is the inguinal single-port approach, which can be performed from an inguinal incision similar to that used in open surgery for inguinal hernias.Case presentationWe performed ECS with an inguinal single-port approach in three older adults. All patients had abdominal wall defects with infection at the central abdominal wound site. A 2–3-cm incision was created in the middle of the inguinal ligament, and a single-port surgical device with two 5-mm trocars was placed in the incision. The external oblique muscle was separated from the internal oblique muscle, and the external oblique aponeurosis was released. The muscle flap of the abdominal wall was moved to the central line. Tension-free abdominal wall closure was possible using a one-handed approach.ConclusionsECS, which has fewer wound complications, requires proficiency. This procedure is a simple and easy-to-perform procedure using an inguinal incision that surgeons are familiar with.