Page 18 - World Journal of Laparoscopic Surgeons

WJOLS

Preoperative Infraumbilical Anthropometry
chronic constipation), side, previous lower abdominal 29 patients had left-sided inguinal hernias. Of the 15 right-
surgery, and proportion (medial, lateral, and scrotal). sided hernias, 8 were indirect and 7 were direct hernias.
Apart from the general physical parameters, special Of the 29 left-sided hernias, 6 were direct and 23 were
emphasis was laid to calculate the BMI. Regional exami- indirect hernias. The BMI of the patients ranged from
nation included the type (direct or indirect), size of deep 18.39 to 22.89 (average: 20.23). The suprapubic fat pad
ring, reducibility, and impulse on coughing. Per rectal thickness ranged from 14 to 31 mm (average: 20.5 mm).
examination was performed in all the patients. There were 10 diabetic, 15 hypertensive, and 3 hypo-
For special anthropometric measurement, the infra- thyroid patients. All these patients were preoperatively
umbilical fat pad thickness was measured in centimeters optimized before surgery.
using Accu-measure calipers taking a single reading from The TEP was the procedure to start with and could be
suprapubic region midway between umbilicus and sym- completed in 33 patients (73.3%), whereas in 12 patients
physis pubis. The value was then interpreted from avail- (26.7%), TEP was converted to TAPP. The patients in
able skin fold to body fat charts available in the market. whom TEP was converted to TAPP had increased BMI
Other parameters measured were distance between (mean 22.53, SD 0.35, p < 0.001) and subcutaneous fat pad
umbilicus (U) and symphysis pubis (SP), U and anterior (mean 27.75, SD 0.27, p < 0.001) respectively. The cause
superior iliac spine (ASIS), interspinous distance and for conversion included difficulty in port insertion and
ASIS to SP. These were measured in centimeters with creation of potential working space. Moreover, during
the help of calipers. port insertion, five patients had inadvertent peritoneal
All the patients were subjected to TEP. Patients in breach due to poor visualization because of excessive pre-
whom TEP failed were converted to TAPP and the reasons peritoneal fat, resulting in pneumoperitoneum. Oozing
for conversion were noted. Patients received a single dose from the dissected fat made visualization difficult due
of linezolid 600 mg at induction. Parenteral fluids were to less illumination. The remaining converted patients
continued for 12 hours and patients were allowed normal had less U–SP length, U–ASIS length, ASIS–ASIS length,
diet thereafter. and SP–ASIS measurements (Table 2). The narrow pelvis
All the patients were discharged on the 3rd postopera- resulted in crowding of instruments and less freedom of
tive day after wound dressing. Stitches were removed on movement.
the 10th postoperative day and patients were followed up Patients in whom TEP was successful had less BMI,
monthly for 3 months and then three monthly for 1 year. subcutaneous fat pad thickness, and wider pelvis (Table 2).
The parameters of each individual patient were There were no preoperative complications. Postop-
statistically analyzed. Student’s paired t-test was used erative complications included seroma formation in five
to compare continuous variables which were normally patients and minor port-site infection in two patients.
distributed. The continuous variables that were not Seroma was aspirated and patients were put on linezolid
normally distributed were analyzed by Mann–Whitney 600 mg for 10 days. Pus was sent for culture from the port
U test, the nonparametric analog for Student’s paired sites which revealed Staphylococcus aureus sensitive to line-
test. The p-value of <0.005 was taken as the threshold zolid. Linezolid 600 mg for 10 days resulted in complete
for statistical significance. The data were analyzed with wound healing. Three patients were lost to follow-up.
the help of IBM Statistical Package for the Social Sciences There was no recurrence in the rest of the patients till date.
version 22.0 (SPSS Inc., Chicago, Illinois, USA) software.
DISCUSSION
RESUlTS AND ANAlYSIS
Open inguinal hernia repair is still performed by numer-
The study included 45 male patients. Age ranged from ous procedures and is less dependent on specific repair
18 to 82 years (average = 44.42 years). Most of the patients for specific hernia. The basic principle of repair remains
(10 patients) belonged to the age group 41 to 50 years. the same with modification in only one step, i.e., repair
There were 34 indirect hernias and 11 direct hernias. There and strengthening of posterior wall. Rather, the choice of
were no patients with femoral hernia in the study group. operation is surgeon-centric rather than hernia-centric.
Direct hernias were more common in elderly patients Various studies claim superiority over one another.
above 60 years of age. Nine of these patients had lower Though Lichtenstein’s tension-free mesh hernioplasty is
urinary tract symptoms and were treated preoperatively the consensus operation, still other operations continue to
5-7
with tamsulosin for 12 weeks and continued postopera- be practiced on a wider scale. Surgeons practicing a par-
tively for 6 months. Patients were assessed by reduction ticular technique continue to carry on with a particular
in symptoms and reduced residual urine on sonography procedure because of more versatility with the procedure
preoperatively. Fifteen patients had right-sided and and better outcome rather than any other issues.
World Journal of Laparoscopic Surgery, January-April 2018;11(1):8-11 9