We report what seems to be the second documented case of perineal hernia after laparoscopic abdominoperineal resection (APR)
and describe its successful repair with transperineal intraperitoneal mesh. An 89-year-old woman complained of a large, painful
perineal swelling 4 months after APR for rectal cancer. Computed tomography (CT) showed small intestine protruding through
the pelvic floor into the perineal area. However, opening of the hernia sac revealed no intra-abdominal adhesions. An oval,
8 × 12 cm Bard Composix Kugel Patch (Davol, Cranston, RI, USA) was inserted into the intraperitoneal space and secured over
the defect in the pelvic floor; then firmly attached to the pelvic wall with 16 interrupted nonabsorbable sutures. There has
been no sign of hernia recurrence in 10 months of follow-up. We speculate that because laparoscopic surgery is minimally invasive,
fewer postoperative adhesions in the abdominal cavity can result in the small bowel sliding more readily into the perineal
area. Based on our experience, perineal hernia after laparoscopic APR can be repaired easily and effectively with a Composix
Kugel Patch. 相似文献
Background This report is an attempt to clarify the effect of diabetes mellitus on perineal wound complications including infectious
entities and delayed wound healing after abdominoperineal resection and also tried to show the risk factors for perineal wound
complications.
Material and methods The data of 80 patients who underwent an abdominoperineal resection were reviewed from April 1996 to March 2006.
Results The rate of perineal wound complications is higher in diabetics (67%) than in nondiabetics (18%, p = 0.005). In a multivariate analysis, diabetes mellitus and operation time (≥420 min) were the risk factors for perineal
wound complications (p = 0.040, p = 0.027, respectively). Infectious perineal wound complication was associated with diabetes mellitus (p < 0.001) but not with the operation time (p = 0.097). Furthermore, a longer comorbid duration of diabetes (≥10 years) was a significant predictor for perineal wound
complications (p = 0.008).
Conclusion This study demonstrated diabetes mellitus to be independently associated with perineal wound complications, and when the patients
have diabetes mellitus, especially with a longer comorbid duration and longer operation time, the clinical path should be
changed to reduce perineal wound complications. 相似文献
Summary When there is significant loss of spinal dura mater, dural substitution with synthetic or allogenic materials is essential.
In the case of laminectomy, mechanical protection and reformation of the dorsal spinal canal may be useful.
This is a report on a patient with total dura loss through tumour atrophy of the dura and laminae. In order to reconstruct
the dorsal face of the spinal canal a polylactide sheet was cut and shaped to fit the physiological contour. A bovine dura
substitute was firmly attached and sutured to the inner surface of the polylactide shield. The implant was wedged in between
the pedicles and the facet joints and resulted in a water-tight dura substitute maintaining the shape of the spinal canal
and protecting it against mechanical forces and intradural scar formation. 相似文献
The transanal pull-through has become the standard operation for Hirschsprung's disease in many pediatric surgical centers. Over the past 8 years, we have modified our technique by leaving a short—rather than a long—rectal cuff and by doing routine intraabdominal colonic biopsies through an umbilical incision before beginning the anal dissection. The aim of this study was to determine if these modifications have changed the outcome for children undergoing this operation.
Methods
A retrospective cohort study of all patients who underwent transanal pull-through by a single surgeon between 1997 and 2005 was conducted.
Results
There were 23 children who had a long cuff (10-15 cm) and 22 who had a short cuff (<2 cm). The short cuff group tended to be younger (25 ± 23 vs 139 ± 67 days; P < .05) and smaller (3.5 ± 0.7 vs 6.0 ± 2.7 kg; P < .05) at the time of surgery. The operating time was shorter (167 vs 186 minutes; P = .05) in the short cuff group. Outcomes were improved in the short cuff group, as evidenced by decreased hospital stay (1.9 ± 0.6 vs 2.7 ± 0.9; P < .05), decreased incidence of enterocolitis (9% vs 30%; P = .1), and lower incidence of narrowing requiring daily dilatations (5% vs 30%; P < .05). Preliminary colonic biopsy was performed on 18 of the 45 patients. This had no significant effect on narcotic use (66% vs 70%; P = .8) and did not increase operating time (174 ± 31 vs 179 ± 34 minutes; P = .6). Hospital stay was shorter in the umbilical biopsy group (1.9 ± 0.6 vs 2.6 ± 0.9 days; P = .006).
Conclusion
Results of the transanal pull-through have improved likely as a result of a combination of experience and use of a shorter rectal muscular cuff. The use of a preliminary colonic biopsy through an umbilical incision has not increased postoperative pain, prolonged operative time, or lengthened hospital stay. 相似文献
Neonates presenting with perineal masses are uncommon. When encountered, most perineal masses are anorectal malformations, sacrococcygeal teratomas, rectal prolapse, or duplication cysts.We present an otherwise healthy newborn with a patent anal canal and a pedunculated anal mass. The mass was initially believed to be a prolapsed rectal duplication cyst. Further evaluation for concomitant congenital abnormalities was negative. The patient underwent mass excision at the bedside under local anesthesia. Histopathologic evaluation revealed benign hamartoma.This case is presented because of its rarity, unique presentation, and simplicity of management. 相似文献
结果:RS泪道引流管置入术组和环形硅胶管置入术组患者术后3mo(94% vs 87%)和术后6mo总有效率(91% vs 83%)比较均无差异(均P<0.05); RS泪道引流管置入术组手术时间、术后眼睑肿胀消退时间均明显短于环形硅胶管置入术组(均P<0.001); RS泪道引流管置入术组患者并发症总发生率低于环形硅胶管置入术组(12% vs 33%,P=0.037)。