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.

Cardiovascular and Renal Outcomes of Incretin-based Therapies: A Review of Recent Clinical Trials

Background

To report the cardiovascular and renal effects of incretin-based therapies.

Methods

The studies of clinical trials on incretin-based therapy published in medical journals from the years 2010 to 2017 were comprehensively searched using MEDLINE and EMBASE with no language restriction. The studies were reviewed and the cardiovascular and renal risks reported were recorded.

Results

Incretin-based therapeutics represent novel and promising anti-diabetes drugs, the direct cardiovascular actions which may translate into demonstrable clinical benefits on cardiovascular outcomes. Furthermore, incretin-based therapies do not adversely affect renal function.

Rectal ischemia causes mass formation, masquerading as rectal cancer

Rectal ischemia rarely occurs because of the rich vascular supply of the rectum, while endoscopic presentation of ischemic colitis always is not distinct and can uncommonly mimic malignant neoplasm. We present a case of a rectal ischemia, which presented with haematochezia and proctoscopy revealed a large ulcerating mass, masquerading as rectal cancer and obstructed the lumen of rectum. However, histological examinations showed only features for ischemic colitis and no evidence for malignancy. The patient was treated conservatively and 10 days later, new endoscopy showed complete disappearance of ulcerated mass, and new biopsies confirmed the initial diagnosis. Awareness and early diagnosis of ‘mass forming’ entity of ischemic colitis is very essential in order to carry out appropriate treatment and avoid severe complications.

A case of De Garengeot's hernia with acute appendicitis and literature review

BACKGROUND

De Garengeot hernia is defined as femoral hernia containing appendix. An acute appendicitis in a femoral hernia is a extremely unusual surgical finding and occurs in 0.08%-0.013% of all cases.

CASE REPORT

We report the case of an elderly woman, who presented with a typical clinical image of incarcerated femoral hernia and underwent open surgery. An infrainguinal incision was performed and after the dissection of hernia sac, an acute appendicitis within femoral hernia was revealed. Subsequently, appendectomy and hernioplasty were performed.

CONCLUSION

Acute appendicitis within femoral hernia should be included in differential diagnosis of patients presenting with clinical signs of an incarcerated femoral hernia and prompt surgical treatment is essential in order to avoid severe complications.