Post-Operative Pain in Transabdominal Preperitoneal (TAPP) Hernia Repair: Mesh Fixation with Tacks Versus Non-Fixation

Objective: To find the post-operative pain in transabdominal preperitoneal (TAPP) hernia repair: Mesh fixation with tacks versus non fixation. Study Design: Comparative study Place and Duration of Study: Department of Surgery Unit B, Mardan Medical Complex, Mardan from 1st October 2019 to 30th September 2021. Methodology: One hundred participants who were admitted for inguinal hernia repair through laparoscopic surgical procedure were enrolled as study participants and divided into two groups. General anesthesia was administered to all patients and a carbon dioxide pressure of 14mmHg was used for keeping pneumo-peritoneum during the surgical procedure. An incision in peritoneum was made post identification of herniasac. Pain index was measured by Visual Analogue Scale at day 1, day 3, day 7 and day 14 followed by one and six months post-surgery. Results: The mean age of group A and group B patients in the present study were 51.2±9.5 and 52.1±9.7 years respectively with majority being males in both groups. Majority of patients in both group had unilateral herni. Group B had shorter surgery duration with lessen hospital stay however chances of recurrence as 12% and wound infection as 6% was higher in it respectively. The post operative pain was 65±9.3 and 66±9.1 in group A and B. Conclusion: Mesh fixation is a longer duration process requiring longer hospital stay, however it provides less chances of complications as wound infection and recurrence. There was no difference in post operative pain in both groups. Keywords: Hernia Repair, Fixation, Mesh, Surgical Method</jats:p

Frequency of Port Site Wound Infection in Laparoscopic Surgery

Objective: To find the frequency of port site wound infection in laparoscopic surgery. Study Design: Retrospective study Place and Duration of Study: Department of Surgery, Rahbar Medical &amp; Dental College, Lahore from 1st October 2020 to 30th September 2021. Methodology: One hundred cases of laparoscopic cholecystectomy were investigated. A standard protocol of National-Nosocomial Infections-Surveillance system as provided by CDC; was applied for identifying port site infection. Weeks assessment was initially done post 7 days of surgery in majority of patients and then after every 7 days for 4 weeks in those having port site infection formation. The demographic information was also documented using a well-designed questionnaire. Results: The age of the patients was between 25-63 years with a mean age of 35.4±2.5 years. There were 52% females and 48% males. Out of the total cases of port site infection 83% cases had epigastric port site infection. Conclusion: Laparoscopic surgery is associated with low risk of port site infection. Keywords: Laparoscopic surgery, Infection, Cholecystectomy, Frequency</jats:p

Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic

Abstract Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P &amp;lt; 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P &amp;lt; 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P &amp;lt; 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection. </jats:sec