Transversus abdominis plane block for pain relief in patients undergoing in endoscopic repair of abdominal wall hernia: A comparative, randomised double-blind prospective study

Introduction: Transversus abdominis plane (TAP) block is now a well-established technique in post-operative analgesia for lower abdominal surgeries. We evaluated the effect of ultrasound-guided TAP block on recovery parameters in patients undergoing endoscopic repair of abdominal wall hernia. Methods: Thirty adults were randomised to receive either ropivacaine with dexmedetomidine (TR) or saline (TP) in TAP block, before emergence from anaesthesia. The patients were assessed for pain relief, sedation, time to ambulate (TA), discharge readiness (DR), postoperative opioid requirement and any adverse events. Results: The median visual analogue scale pain score of the study group (TR) and the control group (TP) showed a significant difference at all time points. TA was 5.3 ± 0.5 (TR) versus 7.4 ± 0.8 (TP), P< 0.001 and DR was 7.5 ± 0.9 (TR) versus 8.9 ± 0.6 (TP), P< 0.001 in hours. No adverse events were observed in any group. Conclusion: This study demonstrates that TAP block is a feasible option for pain relief following endoscopic repair of abdominal wall hernias. It produces markedly improved pain scores and promotes early ambulation leading to greater patient satisfaction and earlier discharge

Totally extraperitoneal repair of inguinal hernia: Sir Ganga Ram Hospital technique

Laparoscopic approach for hernia has evolved rapidly over the past decade. We adopted the TEP repair early as we believe in preserving the sanctity of the coelomic cavity. Once well versed with the approach we have found it an efficient and cost effective method for groin hernia repair. Endoscopic totally extraperitoneal hernia repair is a technically demanding procedure. Indepth anatomical knowledge, training and advanced technical skill is needed for the surgeon to perform this procedure. To make the procedure cost effective and prevent hernia recurrences, we have modified and innovated to simplify the procedure. This modification which we have named the SGRH technique, innovates by creating the preperitoneal working space with the help of an indigenous glove finger balloon. A rolled mesh makes placement and fixation easier in the limited working space. The mesh is unrolled on the peritoneal surface (floor), a manouver which is technically simpler. On desufflation the mesh comes to appose the Fruchad&#x2032;s orifice covering all potential hernial sites. With the modified SGRH technique we have found TEP to be safe, cost effective, reproducible and without significant complications

Totally extraperitoneal repair of inguinal hernia: Sir Ganga Ram Hospital technique

Laparoscopic approach for hernia has evolved rapidly over the past decade. We adopted the TEP repair early as we believe in preserving the sanctity of the coelomic cavity. Once well versed with the approach we have found it an efficient and cost effective method for groin hernia repair

A Review on Obesity and its Management: Focus on Meal Replacement Therapy

Obesity is one of the major health concerns worldwide. In India, over 135 million subjects are affected by obesity. In the last two decades, the prevalence of obesity has increased rapidly. Several factors such as sedentary lifestyle, increased portion size in diet, environmental factors and genetic predisposition are responsible for the increased prevalence of obesity. Obesity also increases the risk of several disease conditions, which has a negative impact on quality of life, work productivity and healthcare costs, leading to a rise in mortality rates. Asian Indians are at a higher risk of developing obesity-related co-morbidities at lower levels of Body Mass Index (BMI) and waist circumference compared with Caucasians. Weight loss is a logical step in the management of obesity. Even a modest weight loss of 5-10% of total body weight has shown to significantly improve health and well-being. A negative energy balance achieved by lesser calorie consumption than expenditure serves as the basic principle for weight loss. The role of Meal Replacement (MR) in the management of obesity is discussed in this review. Studies have shown that MR is effective for safe weight loss. MR is designed to deliver optimum nutrition with a minimum glycaemic index. Optifast by Nestle Health Sciences is one such MR product, which is effective for weight management in individuals with obesity

Adrenal angiomyolipoma: A case report and review of literature

Angiomyolipoma (AML) is a rare mesenchymal tumour arising from perivascular epithelioid cells. It is most commonly seen in kidney, but rarely AML can arise in extra renal sites. Adrenal AML is a very rare clinical entity, and very few cases have been reported so far. We present our experience with a 43-year-old female, who presented with right flank pain. Magnetic resonance imaging showed a right adrenal mass. Laparoscopic adrenelectomy was performed, and the histopathology report confirmed the diagnosis of AML. Patient was discharged uneventfully