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  • ISSN: 2379-0911
    Volume 4, Issue 4
    Case Report
    Shir Li Jee*, Kin Foong Lim, Krishnan Raman, and Harjit Singh
    Squamous cell carcinoma of the gallbladder is rare diagnosis. We report a case of squamous cell carcinoma of the gallbladder diagnosed post cholecystectomy. The patient had presented with symptoms of acute cholecystitis and radiological imaging did not suggest presence of gallbladder malignancy. Emergency laparotomy was performed on clinical diagnosis of a ruptured gallbladder. The diagnosis of gallbladder squamous cell carcinoma was made later from histopathological examination. In this case report, we highlight the limitations of diagnosing gallbladder carcinoma on radiology and the management of gallbladder carcinoma diagnosed intra-operatively. The role of extended radical resection is discussed. In conclusion, squamous cell carcinoma of gallbladder is very rare and has a more aggressive course and poorer prognosis than adenocarcinoma. Aggressive radical surgical approach to achieve R0 curative resection is shown to have improved outcome and better overall 5-year survival for patients with gallbladder cancer.
    Hatice Kaya Ozdogan, Dilek Erdogan Ari*, Murat Secen, and Sefa Ozyazici
    Pheochromocytoma is a rare catecholamine producing tumor. Perioperative anesthetic management for the resection of pheochromocytoma is a challenging issue to anesthesiologist because of its potential for hypertensive crisis. We report anaesthetic management of a case of phaeochromocytoma resection using combination of sodium nitroprusside and sevoflurane, and present a review of the literature.
    Josephine Machoy*, Lhagva Sanchin, Christian Hohaus, and Hans Jorg Meisel
    We report on a 67 years old woman presented with a suprasellar craniopharyngioma with calcification manifesting as a progressive subjective visual deficit. Magnetic resonance imaging showed a 3 x 3 centimeter solid sellar lesion with suprasellar extension and dislocation of the neurovascular structures. The preoperative tentative diagnosis was a craniopharyngioma, this could be verified in the histological examination. At first an endonasal transsphenoidal surgery (TSS) was performed. A second TSS was performed because the patient presented a bitemporal hemianopsia and a recurrent intrasellar tumor with cystic components was radiologically proved. But only a subtotal removal was possible. When new symptoms had been reported, the patient underwent a craniotomy to achieve a gross total resection. Again the total removal was impossible because of the calcified capsule of the tumor and the adhesions with the surrounding neurovascular structures with high risk of loss of function. In follow up MRIs a newly filled cyst was shown and the patient reported again progressive visual deficits. We decided to implant a catheter into the cyst, connected it with a subgaleal reservoir to drain it by percutaneous aspirations. The symptoms relieved immediately and no further surgical resection was needed. Each time the patient described visual problems an aspiration of the fluid was performed. 80-90% of this kind of tumor has cystic components and makes surgical therapy difficult. In the presented case the repeated drainage of cystic craniopharyngioma was an effective palliative treatment.
    Review Article
    Masao Endo*
    This paper reviewed the current procedures for surgical repair of indirect inguinal hernias, highlighting the move from traditional open herniorrhaphy to laparoscopic repair, focusing on the appeal and success of laparoscopic approaches compared to open techniques, and surveyed which method is likely to survive as the gold standard in the future.
    Integrated comparisons did not favor the laparoscopic approach over open repair, because the wide varieties of laparoscopic approaches were associated with varying results. A recent questionnaire administered to 187 attendees of European Pediatric Surgeons’ Association – British Association of Pediatric Surgeons (EUPSA-BAPS) meeting from 46 countries revealed that most pediatric surgeons still favor open techniques and a laparoscopic approach has yet to be accepted.
    Analysis of individualized techniques and outcomes in various morbidities, however, revealed the superiority of laparoscopic techniques over open techniques with regard to greater operative ease, fewer complications, and lower recurrence rates, especially in incarcerated/sliding hernias and recurrent hernias.
    Although laparoscopic hernia repair has not been established long enough to fully consider the risks posed by late complications, growing experience, wider adoption, a decreased prevalence of complications and increasing advantages favor the emergence of the laparoscopic approach as the gold standard in the future.
    Short Communication
    Pashotam Gera*
    Umbilical hernia is a common presentation to paediatric surgery. The indications of surgery range from cosmetic appearance to incarceration of umbilical hernia. We reviewed literature to establish risk of incarceration and age and type of surgery. Umbilical hernias are a common presentation in paediatric surgery clinic, with preponderance towards Afro-Caribbean and premature children. In some African cultures it is a hallmark of beauty and thus parents may be concerned when it is not present. Based on South African data congenital umbilical hernias are present in approximately 15% of children with an incidence of Incarceration estimated at 1:1,500. The data suggests that defects of any size may incarcerate and defects larger than 1.5cm are unlikely to close. These hernias may incarcerate later in life.
    The experience is quite variable in different countries; for example In Nigeria, where the incidence of congenital umbilical hernia is up to 23% and the proportion of acute complications leading to hernia repair is 44% and repair for cosmetic reasons is rare. This is likely to be due to the fact that umbilical hernias are so common that they are culturally accepted and so asymptomatic patients do not feel the need for repair. The incarcerated hernias had defects of average 2cm (0.7-2.5cm) and median age of incarceration was four years.
    Similarly , In India, where the proportion of umbilical hernias repaired due to acute complication is 24% ,it has been advocated for repair of all hernias persisting beyond the age of two years old. This is said to be due to population in remote areas and lack of quick transport available in many centers leading to late presentation of acute incarceration. This is relatively old data and the situation may have improved but it does highlight the impact of isolation in clinical decision making.
    In the USA where acute presentations comprise 7.4% of hernia repairs; there pair of hernias is advocated in defects larger than 1.5cm in diameter in girls over age of two and boys over age of four years.
    Only 10% of adult hernias are congenital in origin. The USA data indicated that medium (0.5cm-1.5cm) hernias are twice as likely to incarcerate as defects of other sizes and that there was no significant sex based preponderance in congenital umbilical hernias.
    In South Africa, where acute presentations represent 7.2% of all hernia repairs; repair is indicated in the case of reported or observed incarceration and if the defects was >2cm in children more than five years of age. The average age of hernia repair was six years old and the average age of incarceration was three years.
    In a recent study published from Western Australia; only 1% of umbilical hernia repairs are performed due to acute complications and given a baby born with an umbilical hernia the risk of incarceration is 1:11,000. Mean age of operation in study population of 433 was 5 years.
    The study was conducted retrospectively and included patient population who underwent umbilical hernia between 1999 and 2012.
    Umbilical hernias in children are rarely associated with incarceration (Intestine or omentum), strangulation, perforation, evisceration and pain. It is important to explain to parents that observation alone is required in most cases and an operation is not commonly required especially in infancy. The most common indication of operation is persistence and cosmetic appearance.
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