Shree Venkatesan, B (2023) A Comparative study between Onlay Mesh Repair Vs Retrorectus Mesh Repair for Ventral Hernias in Diabetic Patients in Terms of Surgical Site Infections. Masters thesis, Madras Medical College, Chennai.
Full text not available from this repository.Abstract
AIMS AND OBJECTIVES: To study about surgical site infections especially in diabetics with ventral hernias who have undergone onlay/retrorectus mesh repair. Primary objective: COMPARATIVE STUDY to find out which method Onlay vs Retro-rectus mesh repair is suitable for ventral hernia repair in diabetics with less surgical site infections (SSI’s) Secondary objective: To find out performance status of patient postoperatively in both arms in terms of functionality and chronic post-operative pain. Methodology. Inclusion criteria: 1. patients >12 years of age. 2. With T1/T2 diabetes. 3. Any ventral hernia, including incisional hernia 4. with minor alignments hypertension, asthma, smoking history, bmi >25 included. Exclusion criteria: 1. Pts <12 years of age. 2. With severe debilitating conditions malignancy, intra-abdominal pathology like TB, skin pathology, blood dyscrasias. METHODOLOGY: ANALYTICAL COMPARATIVE STUDY. STUDY PERIOD: DEC 2020-SEP 2022. STUDY CENTRE: RAJIV GANDHI GOVERNMENT GENERAL HOSPITAL Sample size calculation for comparison of two proportion N= 2[Z1−α/2+Z1−β]²∗[p1q1]+[p2q2]} d2. N=78 total sample size. Z1-α/2= 95% level of confidence Z1-β= power of test i.e., 80%. P1P2= Probability of event in respective groups i.e, 48% and 25% Q1Q2= (1-P1),(1-P2). d2= expected difference in error margin i.e, 9%. STATSTICS: An analytical comparative study was conducted in department of with sample size of 80 which was randomly divided between two groups as 41 for onlay and 39 for retrorectus. Descriptive statistics was given by mean, sd, frequency, percentage and graphs. Analytical statistics was given by chi- square test to find the relationship between groups and other parameters. P-value<0.05 considered to be significant throughout the study. RESULTS: To summarize 80 diabetic patients were studied regarding onlay vs Retrorectus mesh repair in terms of surgical site infections. In this study 51.2% of the participants were included in onlay repair group while 48.8% accounted to retro rectus group. Surgical site infection was present in only 38.8%. There is significant difference between people having surgical site infection and they undergoing different procedures (p-value<0.05). Surgical site infection was seen in 8% in onlay group and none in retrorectus group. The incidence of seroma formation was 20% in the onlay group (15 patients) and 2.67% in the sublay group (2 patients). The erythema rate was 5.63 percent in the onlay group and 1.35 percent in the retrorectus group. In our study, 98.8% of the patients didn’t report recurrence of hernia following repair. The post operative duration of hospital stay in onlay group was mean 12 days (SD 5) and in other group it was 8 days with SD of 5 by Mann Whitney U test. There is no significant difference between recurrence of event and two groups with p-value 0.96. Patient satisfaction in terms of chronic pain was studied and 58.8% of them reported satisfactory which was statistically significant. Mean pain score on post operative day 2,3 and 7 using VAS scale and reported there was statistical difference between both groups for all three days. Compared to those in the sublay group, patients in the onlay group report a greater amount of pain in the days following surgery. CONCLUSION: Sublay (Retromuscular) mesh repair is a good alternative to onlay mesh repairs especially in diabetic patients, this comparative study method of ventral hernia repair CONCURS the same finding as established in reputed journals, it can be applicable to all sites of ventral hernia, the mesh is mostly hidden and anchored behind the rectus sheath, the complication rate is low and there is a low recurrence rate. Post op patient satisfaction rate is better with retrorectus group, than the onlay group .To move forward its better to say that Reterorectus mesh repair may be the ideal technique for ventral hernias in diabetic patients whenever possible.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 220120100518 |
| Uncontrolled Keywords: | Onlay Mesh Repair, Retrorectus Mesh Repair, Ventral Hernias, Diabetic Patients, Surgical Site Infections. |
| Subjects: | MEDICAL > General Surgery > MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Jan 2024 07:36 |
| Last Modified: | 19 Jan 2024 17:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/21308 |
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