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  • ISSN: 2379-0911
    Volume 4, Issue 5
    Case Report
    Chunds EC*, Lebanon B, and La Louviere CT
    Background: Several meta - analyses have validated the "Augmentation" or "Intra - peritoneal on lay mesh (IPOM) - Plus" techniques in laparoscopic incisional and ventral hernia repair (LIVHR) and assessed their safety and efficiency after long - term follow - up.
    The aim of this article is to elaborate on the different techniques available for closing defects by laparoscopy or by combined methods; and defend basic principles with the proper limitations for total laparoscopic use.
    Methods: Through our extensive experience, we observed certain limitations in the use of the total laparoscopic technique when intracorporeal closure of defects exceeding 8 cm in width. The optimal method for laparoscopic defect closure was determined to be the transparietal U reverse stich.
    We found an alternative tailored "Hybrid extracorporeal closure" to be optimal for approximating the linea alba under physiological tension when the defect was 8-14 cm in width. If the width exceeded 15 cm, we preferred to optimize the closure by an anterior component separation technique (CST) followed by laparoscopic IPOM reinforcement.
    Results: Based on personal recently published data, this observational study highlights that the rate of recurrence was optimized but remain greater than 7.08% for larger defects (W4 >15 cm), 9.92% for defects 10-15 cm (W3), and 3.51% for defects 5-10 cm (W2), resulting in an acceptable overall rate of recurrence (4.72%) in comparison to the standard IPOM (4,4-29%).
    Conclusion: The current, best indications for a successful LIVHR should be tailored to the width of the defect and proper patient selection. The Augmentation technique, limited to 8cm width when applied fully by laparoscopy, is highly recommended, for treating incisional and ventral hernias.
    Claudio Birolini*, Jocielle Santos de Miranda, Lenira Rengel, Frederico Teixeira, Edivaldo Massazo Utiyama, and Samir Rasslan
    Background: The degeneration of chronic mesh infection into squamous-cell carcinoma (SCC) of the abdominal is related to a continuous inflammatory response against infection. The treatment is challenging and requires radical tumor resection and simultaneous reconstruction of the abdominal wall. Adjuvant radiation and chemotherapy are necessary to improve the outcomes. The objective of this report is to address rare, but devastating complication of mesh infection.
    Case presentation: We report the case of a patient presenting with an extensive SCC of the anterior abdominal wall, related to a long-standing polypropylene mesh infection. The surgical approach included the resection of the tumor including the right rectus muscle and the small bowel, invaded by the tumor. The reconstruction of the abdominal wall required an intraperitoneal repair with a synthetic coated mesh. He was submitted to adjuvant chemotherapy with Cisplatin and Paclitaxel, and a secondary chemotherapy scheme with Cisplatin and Fluorouracil. Radiation therapy was used to suppress lymph nodal disease in his armpits and groins. The disease progressed with extensive ulceration and infection in his left groin, causing his death after 17 months of follow-up.
    Conclusions: SCC of the abdominal wall is related to chronic mesh infection. Local treatment requires complete tumor excision, along with a challenging reconstruction of the abdominal wall. In this case, the use of a coated synthetic mesh allowed a reliable reinforcement and the closure of an extensive defect, after tumor resection. Adjuvant chemotherapy and radiation therapy were necessary to control metastatic disease.
    Julia Tews*, Lhagva Sanchin, Hans Jörg Meisel, and Christian Hohaus
    A Case report about an intramedullary epidermoid cyst and its association with an arrested ascent of the spinal cord, concomitant the neurological deficits, the surgical treatment and the clinical progress after one year. Epidermoid cysts are rare in the spinal cord, less than 1% of all spinal tumors. A 40-year-old woman described hypesthesia in the right left foot and back pain since one year. The MRI provided the evidence of an intramedullary epidermoid cyst at the level of L1/2 and revealed an arrested ascent of the cord opposite vertebra L3. With total compression of the spinal cord so we decided to operate on her. Intraoperative the intramedullary tumor proved to be an epidermoid cyst with typical pearly appearance and the presence of hair. The surgical removal including capsule was uncomplicated done under neurophysiological monitoring. The hypoesthesia was obviously regressive in the following postoperative days, as well as severe back pain. The MRI after 12 months revealed a fractional cystic alteration. The patient maintained no complaints up to lightly hypesthesia in the right foot. The total resection of epidermoid cyst to avoid recurrence is the main treatment. Neurophysiological monitoring is mandatory.
    Research Article
    Daniela Radu*
    Laparoscopy for diagnostic and operative purposes offers specific advantages to the patient. Apart from the aesthetic appeal, the shorter hospitalization, a more rapid return to normal activity than after traditional open surgery and decreased postoperative morbidity are particularly strong arguments for laparoscopic surgery. Currently, the most frequently performed laparoscopic upper abdominal operation is laparoscopic cholecystectomy. Abdominal peritoneal adhesions, gangrenous gallbladders, and other problems that obscure vision are discovered during about laparoscopic surgeries, forcing surgeons to switch to the standard cholecystectomy for safe removal of the gallbladder. Adhesions and gangrene, of course, can be quite serious, but converting to open surgery does not equate to a complication. One common complication of cholecystectomy is inadvertent injury to an anomalous bile duct known as duct of Luschka. It is non-problematic until the gall bladder is removed, and the tiny duct may be incompletely cauterized or remains unobserved, leading to biliary leak post operatively. The aim of this study is to determine the rate of conversion from laparoscopic to open cholecystectomy and to determine some factors to predict the conversion to open cholecystectomy which might help in properly selecting patients for Day Care ambulatory laparoscopic cholecystectomy, in our clinic.
    Methods: Laparoscopic cholecystectomy was attempted in 2419 patients, 79 (3, 26%) had to be converted to open cholecystectomy. Results: Acute cholecystitis was the commonest reason for conversion (71 patients, 89, 87%). These data confirms the safety of laparoscopic cholecystectomy. Identify a factor which predicts conversion to open cholecystectomy may be helpful in selecting patients for laparoscopic cholecystectomy.
    John W. Murphy* and Ashwin Porwal
    Background: With recent advances in inguinal hernia repairs recurrence is no longer the major consideration. Chronic groin pain is now the most commonly reported complication. Postoperative pain can be divided between immediate and acute post-op and chronic long - term with excessive immediate and acute short - term pain being an indicator for the development of chronic long - term groin pain.
    Material and Methods: A randomized, double - blinded, registered clinical trial enrolling 48 patients was undertaken to compare the amount of immediate and acute short - term pain experienced by patients undergoing a ProFlor repair versus a Lichtenstein repair.
    Randomization was carried out by the surgeon selecting a computer generated sealed envelope in the operating room. Neither the patient nor the follow - up data collector was aware of the procedure performed. The patients were between the ages of 18 and 65and had similar demographics. Recorded Carolinas Comfort Scale, visual analog scale, operative time, return to work and medication consumption results were subjected to statistical analysis.
    Results: The results show that using the ProFlor Dynamic Implant, which requires minimal dissection in the anterior space, avoids the placement of mesh in the anterior space, and requires no fixation, had a statistical difference in regards to Carolinas Comfort Scale and VAS scores, operative time and post - op medication consumption. There were no serious adverse events recorded during the trial period. Conclusions: Proflor repair was superior the Lichtenstein Repair in regards to immediate post - op pain.
    ClinicalTrials.gov identifier: NCT02240550.
    Franscois Runau*, Tamsin Lane, Greg S. McMahon, Andrew S. Miller, Ann Hunter, David Hemingway, and Justin M.C. Yeung
    Mortality rates for neutropenic patients with peri-anal sepsis are high, but there is no consensus in the literature as to the optimal management strategy. At Leicester Royal Infirmary, UK, we have adopted a multidisciplinary approach as standard, with broad-spectrum antibiotics, peri-anal examination with debridement if necessary, and routine defunctioning colostomy. Eleven patients were treated according to this protocol between January 2001 and December 2015, with 9/11 full recovery from the sepsis and the procedure, and 5 subsequently having colostomy reversal. In an area of relatively scant evidence, we conclude that these patients should not be denied a surgical procedure.
    Letter to the Editor
    George Christoudias*
    In 1968, I scrubbed in and watched my first incisional hernia repair as a medical student. This was a suture repair that approximated the edges without tension at the suture line and was considered the standard care at the time. The operating surgeon explained that the goal of any hernia repair is to correct the symptoms or problems that are associated with the hernia - such as pain, discomfort, and disfigurement - and to restore normal abdominal function. Surgical intervention is also necessary to prevent more serious complications such as incarceration and strangulation.
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