2005 SAGES Abstracts

POSTER ABSTRACTS
SAGES 2005
P310–Flexible Diagnostic &
Therapeutic Endoscopy
ENDOSCOPIC REMOVAL OF SIGMOID COLON FOREIGN
BODY: WHAT TO DO WITH A TRAPPED BREAD BAG CLIP?, K J
Wirsing MD, D E Scheeres, M.D., FACS, Grand Rapids General
Surgery Residency Program, Grand Rapids, MI
Introduction: Ingestion of plastic bread bag clips is a rare but
potentially life threatening cause of bowel obstruction or perforation.
At least 25 cases of ingestion of this foreign body
have been reported in the medical literature. We present a
patient who presented with rectal pain and bleeding after she
unknowingly swallowed a plastic bread bag clip, and review
the literature on this topic as well as the relevant anatomy.
Case: A 59 year-old female presented with intermittent hematochezia.
Colonoscopy revealed a foreign body 35 cm from the
anal verge, which was identified as a plastic bread bag clip. Its
two teeth had encircled a haustral fold and eroded through its
base, creating a colo-colonic fistula which trapped the clip in
the colonic mucosa. Attempts to forcibly remove the bag clip
using a polypectomy snare, endoscopic scissors, and toothed
forceps failed.
Following a mechanical and antibiotic bowel prep, a flexible
sigmoidoscopy was performed. An endoscopic sphincterotomy
catheter was passed under the haustal fold through the fistula,
and the opening was enlarged by cutting the haustral
band with the wire directed towards the colonic lumen. After
this, the tip of a snare device was used to incise the top of the
haustrum in a longitudinal fashion to reduce the size of the
fold trapping the bread bag clip. The clip was then grasped
with rat-tooth forceps and manipulated until it disengaged
from the haustrum. The foreign body was removed with no
radiographic evidence of bowel perforation and an uneventful
observation overnight in the hospital.
Conclusion: Bread bag clips that become entrapped on mucosal
surfaces can be difficult to remove. Use of an endoscopic
sphincterotomy catheter and a polypectomy snare to cut the
mucosal fold has not been described in the literature, and is a
safe method to remove this foreign body from the colon.
P311–Hernia Surgery
COMPARATIVE STUDY OF INCIDENCE OF WOUND INFEC-
TION, PAIN AND QUALITY OF LIFE IN PATIENTS UNDERGO-
ING INGUINAL HERNIA MESH REPAIR BY LAPAROSCOPY
AND OPEN METHOD, Sandeep Aggarwal MD, Arvind Kumar
MD,Madhusudan MD,Rajinder Parshad MD,Sandeep Guleria
MD,Hemraj Pal* MD, Department of Surgical Disciplines and
Psychiatry* All India Institute of Medical Sciences, Ansari
Nagar, New Delhi 110029, India
ABSTRACT
TITLE: Comparative Study of incidence of wound infection,
pain and quality of life in patients undergoing inguinal hernia
mesh repair by laparoscopy and open method
BACKGROUND
Laparoscopic surgery for inguinal hernia is gaining increasing
popularity, both among the patients as well as surgeons. The
main reported benefits of the laparoscopic approach to unilateral
inguinal hernia repair are decreased postoperative pain
and decreased wound infection rate. In recent years, the outcomes
of different health care interventions have been
assessed in terms of quality of life. Therefore we did a
prospective non-randomized study to compare the incidence
of wound infection, pain and quality of life in patients undergoing
inguinal hernia repair by laparoscopic and open methods.
Methods
Between January 2002 and November 2003, 90 patients above
15 years of age with a clinical diagnosis of uncomplicated unilateral
inguinal hernia were assigned to open method of hernia
repair by Lichtenstein technique (Group A, n=60) and
laparoscopic hernia repair (Group B, n=30).
RESULTS
There was no significant difference in wound infection rate
between the two groups. The pain scores were higher in the
open group in the early postoperative period. At the end of
three months following surgery, the pain scores were similar
in the two groups. However, there was no difference in the
quality of life in the two groups at any time in the postoperative
period ( at the end of one week, 1 month and 3 months).
CONCLUSIONS
Laparoscopic repair of unilateral inguinal hernia offers no
advantage over open repair in terms of improved quality of
life. However the pain scores are lower in the early postoperative
period in the laparoscopy group allowing early mobilisation
and possible early return to work.
P312–Hernia Surgery
MINILAPAROSCOPIC INGUINAL HERNIA REPAIR, Ferdinando
Agresta (1) MD, Emanuele Santoro (2) MD,Luigi Francesco
Ciardo (1) MD,Giacco Mulieri (2) MD,Natalino Bedin (1)
MD,Massimo Mulieri (2) MD, (1) Dept. of General Surgery, Civil
Hospital, Vittorio Veneto (TV); (2) Dept. of General Surgery
?Nuovo Regina Margherita? Hospital, Rome - Italy.
INTRODUCTION: Laparoscopy has recently been characterised
by an increasing development of smaller laparoscopes, trocars
and operative instruments, thus in order to minimise more
nerve and muscle damage and to optimise aesthetical results.
As a consequence minilaparoscopy has been gradually
employed in the treatment of several pathologies.
Minilaparoscopic surgery has recently commenced in the
treatment of inguinal hernias, similar to its ?major sister?
laparoscopy. The indications for latter are well defined (bilateral
or recurrent hernias or patients desiring or requiring a fast
recovery to resume normal activities), however not completely
clear is the feasibility of the minilaparoscopic technique. The
aim of this study is to evaluate retrospectively the last three
years of patients who underwent minilaparoscopic transabdominal
inguinal hernia repair (miniTAPP) at Our Institutions.
Materials and Methods: Between February 2000 and December
2003 a total of 303 patients (mean age 45 years) underwent a
miniTAPP procedure. Amongst them, 213 (70.2%) were operated
on for a bilateral diseases and 90 (28.7%) for a monolateral
defect, with a total of 516 hernia defects repaired.
Results: No conversion to laparoscopy or anterior open
approach was registered. Major complications were nil whilst
minor occurance ranged as high as 0.3%. Hospital stay was
the same as a laparoscopic approach with a faster recovery to
a normal activity and less analgesic requirement
CONCLUSIONS: On the basis of our initial experience minilaparoscopic
preperitoneal transabdominal hernioplasty is feasible,
effective and easy to perform (without any increase in
technique difficulties) in experienced hands. MiniTAPP provides
positive and comparable results concerning the operative
time, the post op. morbidity and hospitalisation as the
classical LAP. Sparing patients a wider skin incision in the trocars
site might reduce postoperative pain, increase prompt
recovery of gastrointestinal functions, shorten hospitalisation,
help contain health-care costs and increases cosmesis. This
approach appears to play a crucial role in the laparoscopic
approach of all kind of hernias in patients not previously having
had abdominal surgery.
P313–Hernia Surgery
LAPAROSCOPIC VS. OPEN INCISIONAL HERNIA REPAIR: A
COMPARATIVE STUDY., C G Andrew MD, L S Feldman MD,W
Hanna,S Bergman MD,M Vassiliou MD,S Demyttenaere MD,D
Stanbridge RN,G M Fried MD, Steinberg-Bernstein Centre for
Minimally Invasive Surgery, McGill University, Montreal,
Canada.
Introduction: Laparoscopic incisional hernia repair (LIHR) has
been shown to be safe and feasible. However, comparative
studies have had conflicting results. Our goal was to compare
short-term outcomes and recurrence rates after laparoscopic
vs. open incisional hernia repair (OIHR).
Methods: Charts were reviewed of all patients who had elective
mesh repair of incisional hernia at a single institution over
a two year period. Patients were contacted by telephone and
subsequently examined in clinic. Using an intention-to-treat
analysis, LIHR (n=42) and OIHR (n=97) data were compared
using Student?s T, Chi Square, and rank sum tests.
Results: Both groups were similar with respect to age, gender
and ASA. There were more morbidly obese patients in the
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