P-041 THE IMPACT OF COVID-19 ON ELECTIVE INGUINAL HERNIA REPAIR: A SINGLE-CENTER EXPERIENCE

Background – Aim

Inguinal hernia repair is among the most common surgical operations worldwide with over 20 million performed yearly. During the COVID-19 pandemic most elective hernia repairs were canceled, leading to potentially detrimental effects on the patients suffering from them. The aim of this study was to assess the impact of the pandemic on inguinal hernias and elucidate its consequences.

Material & Methods

Patients that underwent inguinal hernia repair at General Hospital of Amfissa from March 2018 to March 2022 were included in this study. Patients were divided into two groups before (Group A) and after (Group B) March 2020, the date on which the first lockdown was implemented in Greece.

Results

Overall, 407 patients (382 males & 25 females) with a mean age of 69 (24–93) were included in this study. A 27.5% decrease in total surgeries was found during the Group B (236 vs 171 patients), but emergency surgeries significantly increased (17.3% vs 43.9%). Furthermore, there was a statistically significant increase in strangulated cases (15.3% vs 40.4%) and cases warranting a bowel resection (13.6% vs 39.2%). Mean length of hospital stay also significantly increased over Group B period (1.69 vs 3.02 days).

Conclusions

Policies leading to cancelation of elective surgeries and reallocation of healthcare facilities in order to confront the COVID-19 pandemic have led to a significant delay in the management of inguinal hernias. Thus, a steep increase in emergency cases was observed, as a greater part of theses hernias are being left untreated and subsequently strangulated.

P-028 POSTOPERATIVE ASSESSMENT OF PAIN AFTER LICHTENSTEIN TENSION-FREE MESH INGUINAL HERNIA REPAIR

Background-Aim

Effective postoperative pain management is vital for the well being of the patients after inguinal hernia repair. The aim of this study was to assess the analgesic efficacy and safety of parecoxib sodium versus diclofenac sodium following inguinal hernia repair.

Material & Methods

Patients that underwent from 1/1/2019 to 31/12/2020 an Lichtenstein tension free inguinal hernia repair at General Hospital of Amfissa were included in this study, They were randomly assigned to receive postoperatively parecoxib 40mg twice daily iv (group A), or diclofenac 75mg twice daily im (Group B). Tramadol 50mg iv was used as “rescue” treatment. Pain Rating System (PRS) was utilized for pain assessment.

Results

214 patients (162 males, 52 females) with a mean age of 72 (26–93) years were included in this study. Patients receiving parecoxib sodium experienced significantly lower PRS scores at 6 hours postoperatively (2.2 vs 3.1) and 24hrs postoperatively (1.2 vs 2.0). Fifty-nine patients (27.8%) needed a “rescue” analgesic treatment with the majority of them (43 patients) belonging to the Group B. 96.7% of total patients left the hospital on 1st postoperative day without needing any additional analgesic treatment.

Conclusions

Administration of parecoxib sodium 40mg twice daily is more effective than diclofenac for pain management after inguinal hernia repair.

The effectiveness of reinfusion after total knee replacement. A prospective randomised controlled study

The purpose of our study was to determine the effectiveness of a postoperative autologous blood reinfusion system as an alternative to homologous, banked blood transfusions in total knee arthroplasty. We carried out a prospective randomised controlled study on 60 patients having unilateral total knee replacements. In all these patients, the same surgical team applied the same surgical technique, and all patients followed the same rehabilitation program. In 30 of these patients (group A), a reinfusion system of unwashed salvaged blood was applied, and they were supplemented postoperatively with banked blood transfusions when required. A control group of 30 patients (group B), in whom standard suction drains were used, received one unit of homologous banked blood transfusion intraoperatively and additional blood transfusions postoperatively when required. The administration of banked blood transfusion was determined by the haemoglobin value (<9 mg/dl) and/or clinical signs (blood pressure, pulse, etc.). The values of haemoglobin, haematocrit and platelets were recorded preoperatively and the first, fifth and 15th postoperative days, respectively. Five patients of group A required nine units of homologous blood (0.3 units/patient) postoperatively. Ten patients of group B required an additional 15 banked blood units postoperatively (in total 45 banked blood units for group B; 1.5 units/patient). In the study group, the total homologous blood requirements were reduced by 80%, while the postoperative blood requirements were reduced by 50%. There was no significant difference in the postoperative haematocrit and haemoglobin values between the two groups. The cost of the blood management in the study group was reduced by 36%. The use of an autologous blood reinfusion system reduces highly effectively the demands of homologous banked blood transfusion in total knee arthroplasty.

Diameter of mammary terminal ducts as an additional tool in evaluation of women with polycystic ovarium disease

OBJECTIVE

Aim of this study was to show the change of diameter of mammary ducts in relation to polycystic ovaries disease.

DESIGN

Women who took part were divided into two groups- the first with polycystic ovaries disease and another second group with no such disease.

METHOD

To both groups a series of laboratory, clinical and ultrasound (u/s) exams were used to diagnose polycystic ovaries disease. Furthermore u/s measurement of mammary ducts was used to define the diameter.

RESULTS

In women with polycystic ovaries disease u/s showed an increase in diameter of mammary ducts whereas in the second group we didn't observe such finding.

CONCLUSION

Our study showed that there seems to be a strong relation between the increased diameter of the main terminal lactiferous ducts- the polycystic configuration of the ovaries and the hormonal levels.

Splenic artery aneurysm rupture

BACKGROUND

Splenic artery aneurysms are uncommon even though they are second only to those of the aorto-iliac system. There is also controversy regarding their management.

METHODS

We report the case of a 50-year-old patient with ruptured splenic artery aneurysm and review the literature regarding its diagnosis and management.

RESULTS

The patient underwent emergency laparotomy and splenectomy was performed.

CONCLUSION

Resuscitation and an aggressive surgical approach should be taken in order to save the life of the patients.

Increased temperature of malignant urinary bladder tumors in vivo: the application of a new method based on a catheter technique

PURPOSE

The aim of this study was to investigate the existence of any thermal difference between malignant tumors and inflammatory benign lesions of the human urinary bladder and to determine whether it correlates with tumor angiogenesis quantification.

PATIENTS AND METHODS

A new method, developed in our institute, is introduced to detect temperature in human urinary bladder, in vivo. This method is based on a thermography catheter. We calculated the differences of the temperature of the solid tumor and of a normal area (Delta T) on 20 subjects (mean age, 72.5 years; 95% confidence interval [CI], 68.5 to 76.4). According to the biopsy histology, Eight (40%) patients had benign tumors, and 12 (60%) had malignant tumors.

RESULTS

We found significant differences of Delta T between patients with benign and malignant tumor (P <.001). Also, differences were found for the mean values of angiogenesis level between malignant and benign tumors (P =.0261), and a moderated positive correlation was estimated between the degree of angiogenesis and Delta T (P =.02). Based on logistic regression analysis, we found that a 1-degree increase of Delta T triples the odds of a patient having a malignant tumor (odds ratio = 2.91; 95% CI, 1.97 to 7.78; P <.001), adjusted for the degree of angiogenesis (P =.0236) and the grade of tumor (P <.001). A threshold point of Delta T = 0.7 degrees C was determined, with sensitivity 83% and specificity 75%.

CONCLUSION

These findings suggest that the calculated difference of temperature between normal tissue and neoplastic area could be a useful criterion in the diagnosis of malignancy in tumors of the human urinary bladder.

Sclerosing sertoli cell tumor of the testis--a case report and review of the literature

To date, only I I cases of sclerosing Sertoli cell tumors have been reported in the literature, representing a distinctive subtype of Sertoli cell tumor in humans. We present a 12th case with a review of the current urological and pathological literature.

Prostatic tissue distal to the verumontanum and its significance for adenomatous recurrences after transurethral resection of the prostate. A cadaver study

To elucidate possible causes of recurrences after transurethral resection of the prostate (TURP), we performed an anatomical study of the prostate in 37 cadavers. The anatomical study showed that a significant proportion of the prostatic adenoma laid below the verumontanum. This proportion in relation to the total prostatic length varied from 8.33 to 44.44%, while in relation to the weight it varied from 2.08 to 36.84%. After transurethral resection of the prostatic adenoma, part of the apical lobes below the verumontanum remains intact deliberately to secure continence. These adenomatous tissues left behind create the problem of the residual apical lobe. Recent reports in the literature have shown a higher incidence of prostatic adenomatous recurrences following TURP than after open prostatectomy. From our study and from an extended search in the literature, it seems that a possible reason for adenomatous recurrences can be due to the remaining residual apical lobes that are left behind after TURP, providing that the resection had been complete.

A clinical diagnosis of urinary bladder (extra-adrenal) phaeochromocytoma

Urinary bladder (extra-adrenal) pheochromocytoma is a catecholamine-producing tumor that arises from chromaffin cells in the extra-adrenal paraganglion system of the urinary bladder. The symptoms and signs result from the release of epinephrine and/or non-epinephrine, which is more prominent during micturition. The most serious consequences of the disease are paroxysmal hypertension during micturition and malignant degeneration. Thus, proper treatment is mandatory.

Ureteral endometriosis in a female patient presenting with single-kidney anuria

Endometriosis affecting the urinary tract is very rare. We report on a female patient with a single kidney who presented with anuria due to ureteral endometriosis. Initially a limited ureterectomy with an end-to-end anastomosis was performed. After removing the stent, endometriosis recurred. On reexploration, the terminal ureter was removed and the sound end reimplanted into the urinary bladder. A salpingo-oophorectomy was performed, and danazol 400 mg twice daily was started, with very satisfactory results. Endometriosis on a single acquired ureter causing anuria has, to our knowledge, not been reported previously. The modality of treatment is local excision, oophorectomy, and danazol.

X-ray diffractometric analysis of L-cystine stones in 12 patients

In 12 of 21 cystinuric patients, the components of cystine stones, either previously passed or removed at surgery, were studied by X-ray diffractometry and chemical analysis. The results of diffractometry suggested that, in addition to cystine, the stones contained sodium urate and ammonium magnesium orthophosphate hydrate, although chemical analysis was negative for these components. The role of uric acid in cystinuria is discussed.

Metabolic disturbances in cystinuria

Metabolic investigations were made in 21 cystinuric patients. The results showed a low output of urinary phosphorus and an increase of plasma IgG. These findings and the presence of uric acid in the urine, even in normal values, could play an important role in pathogenesis and stone formation, and also in cystinuria.

Surgical management of renal staghorn calculi by selective hypothermic perfusion

18 patients with unilateral staghorn calculi managed by selective hypothermic perfusion are presented and the results reported. The procedure proved to be simple, safe and effective in the management of most staghorn calculi.