Rajiv Gandhi University Of Health Science

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA

ANNEXURE- 2

SYNOPSIS FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF CANDIDATE AND KUMAR S S ADDRESS PG STUDENT DEPARTMENT OF GENERAL SURGERY BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE BANGALORE 560002

2 NAME OF INSTITUTION BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, BANGALORE -560002

3 COURSE OF STUDY AND M.S. IN GENERAL SURGERY SUBJECT 4 DATE OF ADMISSION TO 31-05-2008 THE COURSE 5 TITLE OF TOPIC CLINICAL STUDY OF THE ROLE OF STOPPA’S REPAIR IN CASES OF HERNIA REPAIR. 6. BRIEF RESUME OF THE INTENDED WORK

6.1 NEED FOR STUDY:

Hernias are one the most common surgical procedures done in general surgery. Prevalence of hernias in general population is about 5%. with the invent of tension free repair of hernias there was remarkable decrease in recurrence rate, but still there is 5% recurrence and one study has shown that the opposite side is involved in 28% of the patients after 12 months of follow-up which require surgical intervention.

The aim of present study is to study the role of stoppa‘s mesh repair in cases of Recurrent hernias, Bilateral hernias ,Hernia associated with risk factors like old age, COPD, weak abdominal wall. Sliding hernias and to study outcome and complications of surgery.

6.2 REVIEW OF LITERATURE:

Hernias are the most common elective procedures done in general surgery. This common problem. This common problem has seen evolution from pure tissue repair to tension free repair to laparoscopic repair of hernias.

Stoppa’s repair involves the repair of the hernia with reinforcement of parietal wall which covers all myopectineal orifices which is defective in femoral, inguinal, and other lower abdominal hernias.

Stoppa’s hernia is required is preferred to laparoscopic repair for its low cost, shorter operating time, short learning curve, low risk of bowel and bladder injury. Stoppas provides the definitive and safe cure for complex bilateral hernias because of its simplicity ease of procedure excellent results and low complications.

Giant preperitoneal reinforcement of visceral sac (GPRVS) has gained rapid wide acceptance and is a valuable addition to the surgeon’s armamentarium fir effective and safe treatment of hernias.

Recurrence rate is very low even when used for recurrent hernias; this fact is being supported by many prospective controlled trials. GRVS also known as Stoppa’s repair is logical method. It is an operation correctly adopted to cure and to the prevention of recurrence of certain hernias notably.

1. Primary bilateral inguinal hernias.

2. Recurrent inguinal hernias.

3. Complex inguinal hernias.

4. Complicated inguinal hernias, e.g. sliding hernias.

It is an anatomic suture less tension free technique. It focuses on retaining peritoneum rather than repairing the peritoneal defects. It is the only repair that reliably eliminates all hernias of the groin including perivascular femoral hernias.

It has many intra operative advantages:

1. Simplicity due to quick incision.

2. No bloody dissection of retrofacial spaces.

3. Good exposure of the hernial orifices.

4. Facility of perietalization of elements of spermatic cord.

5. No dangerous maneuvers causing threat to ileofemoral vessels.

6. No need to close the hernial orifices or fix the prosthesis.

7. Benign nature of the operation leads to smooth post operative course and thus needs only a short period of hospitalization.

6.3 OBJECTIVES OF STUDY:

1. Study the indications of the stoppa’s repair.

2. To study stoppa’s repair and its complications.

3. Recurrence rate after 12 months of follow-ups.

4. To study the use of drain in stoppa’s repair. 7 MATERIALS AND METHODS

7.1 SOURCE OF DATA:

 Present study will be done on about 30 people treated with stoppa’s repair for various indications mentioned above victoria hospital and other hospitals attached to BMC & RI.

7.2 STUDY DESIGN:

 Prospective study.

7.3 STUDY POPULATION:

 Total population of patients studied are all the patient with hernia admitted to the hospital.

7.4 INCLUSION CRITERIA

1. Cases of bilateral inguinal hernia. 2. Recurrent hernias. 3. Multiple hernias. 4. Unilateral direct hernias associated with risk factors like age >60 years, those with COPD , weak abdominal wall, abdominal eventrations, Recurrence, Cirrhosis, Collagen vascular desease, Hernias which are more than >5 cm.

7.5 EXCLUSION CRITERIA:

1. Those hernias associated with intestinal obstruction , stanguation, infected hernias. 2. Unilateral hernias in otherwise narmal adult. 3. Who refused to give consent for surgery. 4. Those who are not fit for surgery. 7.6 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY:

1. Routiene investigations like Haemoglobin, bleeding and cloting time, rndom blood sugar, blood urea , serum creatinine, CXR,ECG,) 2. USG abdomen with scrotum. 3. Investigations to know post operative complications if required.

7.7 HAS ETHICAL CLEARENCE OBTAINED FROM YOUR INSTITUTION AS IN CASE OF 7.6- OBTAINED:

8 LIST OF REFRENCES:

1) Stoppa R E, Warlaumont C R , Midline preperitoneal approach to prosthetic repair of groin hernias. Nyhus L M, Baker R J , Mastery of surgery 4 rd edition.2008 1859-1869. 2) Stoppa R E, Warlaumont C R-The pre peritoneal approaches and prosthetic repair of groin 3) Schwrtz principles of surgery. 7 th edition, page number 1123 4) Thappar V V ,rao P P, gaint prosthesis for reinforcement of viceral sac for bilateral recurrent hernias . JPMd2000;46;80 5) Sabiston text book of surgery 18 th edition page no 998 6) Beets GL, van Geldere D, Baten CG, Go PM. Long term results of giant prosthesis for reinforcement of visceral sac for complex recurrent inguinal hernias. Br J Surg 1996; 83:203-206. 7) Stoppa RE. The treatment of complicated groin and incisional hernias. World J Surg 1989; 13:545-554. 8) Solorzano CC, Minter RM, Childers TC, Kilkenny JW 3rd, Vauthey JN. Prospective evaluation of giant prosthesis for reinforcement of visceral sac for recurrent and complex bilateral inguinal hernias. Am J Surg 1999; 177:19-22.

9 SIGNATURE OF CANDIDATE : Dr. KUMAR .S.S

10.REMARKS BY GUIDE: Giant preperitoneal reinforcement of visceral sac (GPRVS) has gained rapid wide acceptance and is a valuable addition to the surgeon’s armamentarium fir effective and safe treatment of hernias.

Recurrence rate is very low even when used for recurrent hernias; this fact is being supported by many prospective controlled trials.

This study can be can be taken up as dissertation topic as continuous study need to be done about the hernia repair.

11 NAME AND DESIGNATION OF:

11.1 GUIDE PROFF. T. DURGANNA.

PROFESSOR AND HOU

DEPARTMENT OF SURGERY

BMC AND RI

BANGALORE

11.2SIGNAUTURE

11.3 COGUIDE NO 11.4HEAD OF DEPARTMENT: DR. B S SHIVSWAMY

PROFESSOR AND HEAD OF DEPARTMENT

DEPARTMENT OF GENERAL SURGERY

BMC AND RI

BANGALORE

11.5 SIGNATURE

12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL:

12.2SIGNATURES