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INTRODUCTION: Parastomal hernia occurs in 35%-50% of patients who have had a stoma formed, whether for the digestive tract or the urinary tract. There are many repair techniques including primary repair and repair using different ...
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INTRODUCTION: Parastomal hernia occurs in 35%-50% of patients who have had a stoma formed, whether for the digestive tract or the urinary tract. There are many repair techniques including primary repair and repair using different types of mesh prosthesis, and the surgical approach may be open or laparoscopic. However, all techniques suffer the disadvantage of a high index of hernia recurrence. PATIENTS AND METHODS: This study included 125 patients from the stoma clinic at our hospital. Hernia repair was performed on 25 of these patients who had a terminal colostomy because of either cancer or inflammatory disease. Preoperative colon preparation involved a cathartic, an evacuating enema, and antibiotic therapy in the preoperative period. The repair was conducted via an anterior approach, dissecting the skin around the stoma in the way a plastic surgeon handles an umbilical scar during abdominoplasty, in order to enter the hernia site. The hernial sac was left intact to form a bed on which to lay a lightweight polypropylene mesh, and this was then fixed to the deep face of the aponeurosis all around the stoma, with sutures placed in a U-shape with 1/0 or 2/0 non-absorbent material. The mesh was also fixed to the external surface of the colon with simple sutures of 3/0 polyglycocolic acid. A closed supra-aponeurotic drain was left in situ, and the skin was closed with 3/0 nylon. RESULTS: Of the corpus, 50 patients presented with parastomal hernia (40%), and 25 of them underwent surgery. These patients were followed for a period of 12 months, on average (range: 8-24 months). After operation, 2 patients (8%) experienced hernia recurrence and underwent further surgery to reinforce the abdominal wall with a new insertion of mesh prosthesis; 2 patients (8%) suffered surgical wound infection; and 2 patients (8%) developed a seroma. There was no rejection of the mesh, erosion of the colon, or fistula formation. CONCLUSIONS: Inserting a mesh prosthesis by this technique is a safe effective treatment for parastomal hernia, adding another option to the available repair solutions. Prospective and comparative studies are required to reinforce this study, and they should ideally include a greater number of patients in the study corpus.
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INTRODUCTION: Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. METHODS: The clinical notes for 4093 patients over the age of 16 who had undergone appendectomy were reviewed. Particular attentio...
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INTRODUCTION: Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. METHODS: The clinical notes for 4093 patients over the age of 16 who had undergone appendectomy were reviewed. Particular attention was paid to the histopathologic results, separating out those cases where trophozoites were seen in the appendix. These cases were considered to be of amebic origin. RESULTS: A total of 93 cases reported lesions suggestive of amebiasis (2.3%). This study analyzed 86 of these cases. Comparing the cases in this study against the cases of patients with acute appendicitis in general (excluding the cases of amebic origin), no differences were found in relation to the distribution or presentation according to sex or in the degree of inflammation of the appendix, the incidence of surgical wound infection, or general complications. By contrast, the study noted a statistically significant difference in the age at presentation: Acute appendicitis of amebic origin presents principally among those under 20 years of age and is accompanied by a higher frequency of fecal fistula (2.3%). CONCLUSIONS: Acute appendicitis of amebic origin is not seen frequently, and in general it does not behave any differently from other cases of acute appendicitis, except in its earlier presentation and its greater incidence of fecal fistula. The condition is suspected clinically whenever a cecum of hard, "cardboard-like" consistency is discovered.
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Xanthogranulomatous cholecystitis (XGC) is one presentation of cholecystitis and can be a cause of difficulty in cholecystectomy. We reviewed the clinical files of 12,426 patients who had undergone cholecystectomy. In this group, ...
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Xanthogranulomatous cholecystitis (XGC) is one presentation of cholecystitis and can be a cause of difficulty in cholecystectomy. We reviewed the clinical files of 12,426 patients who had undergone cholecystectomy. In this group, there were 182 cases of XGC, and 41 of these patients had undergone laparoscopic surgery. Patients with XGC represented 1.46% of the cholecystectomies that were performed. Of the 41 patients who underwent laparoscopic surgery, 27 were men (66%) and 14 were women (34%) (average age, 52 years). A total of 36 patients (88%) presented with a chronic condition. XGC was found to be associated with lithiasis in 85%, with jaundice in 22%, and with cancer in 2.4% (one patient). A total of 33 patients (80%) required conversion to open surgery, because of technical difficulties; of these patients, 64% underwent partial cholecystectomy. We conclude that XGC creates difficulty at laparoscopy and therefore any preoperative suspicion of XGC should cause the clinician to consider open cholecystectomy.
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The demographic and clinical aspects of xanthogranulomatous cholecystitis (XGC) over a period of 15 years are reviewed. The review entailed examining 12,426 clinical files of patients who had undergone cholecystectomy, including 1...
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The demographic and clinical aspects of xanthogranulomatous cholecystitis (XGC) over a period of 15 years are reviewed. The review entailed examining 12,426 clinical files of patients who had undergone cholecystectomy, including 182 patients with a histopathologic diagnosis of XGC. Altogether, 1.46% of the cholecystectomies performed were done on patients with a diagnosis of XGC. XGC presented in patients over the age of 32, with a male/female ratio of 2:1. Thickening of the gallbladder wall, seen on ultrasonography and computed tomography scans, was demonstrated in 100% of the cases. A total of 17% of the cases presented in acute form. Obstructive jaundice was observed in 23% of the patients, 11 of which cases were associated with choledocholithiasis (30% of these patients had jaundice) and the rest with extrinsic obstruction of the bile tract (Mirizzi syndrome). XGC was associated with lithiasis in 85% of the cases. A malignant lesion was suspected during operation in 30% of the cases, requiring histopathologic examination during surgery. Carcinomatous lesions were found in 3% of the cases. Surgical difficulty was reported in 65% of the cases, resulting in the performance of partial cholecystectomy in 35%. XGC is an infrequent form of chronic inflammation of the gallbladder, the clinical presentation of which is similar to that of cholecystitis; given the thickening of the gallbladder wall, it makes cholecystectomy difficult. As XGC may resemble adenocarcinoma, differentiation is essential by means of intraoperative histologic examination to ensure optimal surgical treatment.
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This paper describes a simplified technique for the repair of incisional hernias. The previous scar is resected, and the peritoneal sac is carefully dissected until it is completely exposed. The sac is opened to liberate structure...
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This paper describes a simplified technique for the repair of incisional hernias. The previous scar is resected, and the peritoneal sac is carefully dissected until it is completely exposed. The sac is opened to liberate structures adherent to the sac or to the area immediately surrounding the defect. The peritoneum is closed and invaginated to form a sac bed underlying the entire extent of the defect, and the mesh is laid on this sac bed. The mesh is then fixed with "U" stitches, reinforcing these by inserting a second line from the edge of the defect to the mesh. Suture material used is polypropylene 1/0 or 2/0. This procedure has been carried out on 15 patients, and after 1 year of follow-up, there has been no recurrence of the hernia. Operating time was reduced, and the surgical technique was found to be easier. Placing a mesh prosthesis inside the hernia sac and fixing it to the abdominal wall with two lines of suturing simplifies the repair procedure, reduces operating time, and is effective in the repair of all incisional hernias. A study is required to compare this outcome with the different mesh repair techniques.
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Spermatic cord liposarcoma (SCL) is a rare medical condition; to our knowledge there have been fewer than 100 cases reported in the literature worldwide. As a group, para-testicular tumors are relatively uncommon, and they must be...
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Spermatic cord liposarcoma (SCL) is a rare medical condition; to our knowledge there have been fewer than 100 cases reported in the literature worldwide. As a group, para-testicular tumors are relatively uncommon, and they must be differentiated from tumors of testicular origin with extension to the spermatic cord and its elements. SCL should be suspected in patients experiencing recurrent hernias of the inguinal region. Herein we present two cases of SCL recently diagnosed at our hospital. In both instances, the preoperative diagnosis was inguinal hernia.
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