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1.
Background
Chronic groin pain appears in athletes with a diverse etiology. In a select few, it can be defined as a sportsman’s hernia, that may be related, among other pathologies, to weakness of the posterior inguinal wall and may successfully respond to surgery.Hypothesis
Surgical repair of the sportsman’s hernia is associated with good functional outcomes, if the diagnosis is based on meticulous examination and follows a simple selection flowchart.Study design
Prospective case cohort study.Methods
The study assessed patients recruited from 2006 until the present assessed by a dedicated team with clinical and radiographic features of a sportsman’s hernia who had failed a specified period of conservative therapies. Surgery was performed using a tension-free mesh open inguinal hernia repair.Results
Of 246 male patients with chronic groin pain, 51 underwent surgery (mean age 20.7 years, range 14–36 years) with 58 inguinal procedures performed. Of the operated group, seven underwent bilateral surgery with a direct hernia found in 9/58 operated sides (15.5 %), an indirect hernial sac in 8/58 (14 %) and a direct and indirect hernia being found in 3/58 (5 %) of operated sides. There was no post-operative morbidity (median follow-up 36.1 months; range 1–74 months), with two failures (3.45 % of operated sides). All other patients were asymptomatic, returned to full sports activity within 4.3 weeks (range 3–8 weeks) after surgery, and required no analgesics or further treatment.Conclusion
Selective surgical hernia repair, based on meticulous anamnesis and physical examination is effective in the management of chronic groin pain in athletes.2.
Purpose
Our aim was to investigate how often a national cohort of experienced groin hernia surgeons transected the round ligament of uterus in laparoscopic groin hernia repair. Furthermore, we wished to explore the surgeons’ personal opinions and knowledge on the function and importance of the ligament.Methods
An electronic questionnaire was sent to all surgeons in Denmark performing laparoscopic groin hernia repair on a regular basis. The questionnaire consisted of demographic details, estimated incidence of transection of the round ligament of uterus, information about transection to the patients, documentation of transection in the medical records, and the surgeons’ personal opinions and knowledge of the importance of the ligament.Results
A total of 71 surgeons met our eligibility criteria and 61 (86%) provided complete responses. We estimated that the round ligament of uterus was transected in 395 of 813 (49%) herniorrhaphies during the past 12 months. Personal opinions and knowledge on the function of the ligament and the importance of preserving it varied greatly among the surgeons.Conclusions
Transection of the round ligament of uterus in laparoscopic groin hernia repair is common. The consequences of transecting the round ligament of uterus are not well described, and opinions and knowledge on the issue vary widely among experienced hernia surgeons.3.
B. Hohendorff F. Biber H. Sauer C. Ries C. Spies J. Franke 《Operative Orthopadie und Traumatologie》2016,28(1):4-11
Objective
Correction of residual flexion deformity of the proximal interphalangeal (PIP) joint after excision of diseased connective tissue in Dupuytren’s contracture by stepwise arthrolysis.Indications
Flexion deformity of the PIP joint of 20° or more after excision of the diseased connective tissue in Dupuytren’s contracture.Contraindications
Joint deformities, osteoarthrosis, intrinsic muscle contracture, instability of the PIP joint.Surgical technique
Arthrolysis of the PIP joint is performed by six consecutive steps: dissection of the remaining skin ligaments, opening the flexor tendon sheath by transverse incision at the distal end of the A2 pulley, dissection of the checkrein ligaments, dissection of the accessory collateral ligaments, releasing the palmar plate proximally, releasing the palmar plate up to its insertion at the middle phalanx base.Postoperative management
Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days, occupational/physical therapy, static and possible dynamic extension splint several weeks/months.Results
A total of 31 fingers in 28 patients with Dupuytren’s contracture were evaluated an average of 22 months after arthrolysis of the PIP joint. In all, 26 joints with an average recurrent flexion contracture of 29° were improved compared to the preoperative flexion contracture of 81°; 4 PIP joints with a recurrent flexion contracture averaging 60° were worse. In one patient, PIP flexion contracture of 90° was unchanged at follow-up although the joint could be extended intraoperatively to 10° of flexion.4.
Purpose
The pathogenesis of groin hernia is not fully understood and some suggested risk factors are debatable. This population-based study evaluates the association between groin hernia repair and tobacco use.Method
An observational study based on register linkage between the Swedish Hernia Register and the Västerbotten Intervention Program (VIP). All primary groin hernia repairs performed from 2001 to 2013 in the county of Västerbotten, Sweden, were included.Results
VIP provided data on the use of tobacco in 102,857 individuals. Neither smoking nor the use of snus, increased the risk for requiring a groin hernia repair. On the contrary, heavy smoking decreased the risk for men, HR 0.75 (95% CI 0.58–0.96), as did having a BMI over 30 kg/m2 HR (men) 0.33 (95% CI 0.27–0.40).Conclusion
Tobacco use is not a risk factor for requiring a groin hernia repair, whereas having a low BMI significantly increases the risk.5.
L. Walle B. Hohendorff T. Pillukat J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(1):38-46
Objective
Closure of a palmar soft tissue defect of the proximal phalanx after limited fasciectomy in recurrent Dupuytren’s contracture.Indications
A palmar soft tissue defect between the distal flexion crease of the palm and the flexion crease of the proximal interphalangeal joint (PIP) after limited fasciectomy in Dupuytren’s contracture.Contraindications
Scars at the lateral–dorsal portion of the proximal phalanx (e.g., after burns).Surgical technique
Modified incision after Bruner (“mini-Bruner”). Removal of the involved fascial cord. If necessary, arthrolysis of the PIP. Raising the lateral–dorsal transposition flap from distal to proximal and rotating it into the palmar soft tissue defect of the proximal phalanx. Closure of the donor site with a skin transplant.Postoperative management
Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days. Afterwards static dorsal splint and daily physiotherapy.Results
Between 2002 and 2007, a total of 32 lateral–dorsal transposition flaps in 30 patients with recurrent Dupuytren’s disease of the little finger underwent surgery. In a retrospective study, 19 patients with 20 flaps were available for follow-up evaluation after a mean of 6 years. All flaps had healed. The median flexion contracture of the metacarpophalangeal joint was 0° (preoperatively, 20°), and of the PIP 20° (preoperatively, 85°) according to Tubiana stage 1 (preoperatively, Tubiana stage 3). The median grip strength of both the operated and the contralateral hand was 39 kg. The DASH score averaged 11 points. Overall, 11 patients were very satisfied, 6 patients were satisfied, 1 patient was less satisfied, and 1 patient was unsatisfied.6.
E. Oma M. Bay-Nielsen K. K. Jensen L. N. Jorgensen A. Pinborg T. Bisgaard 《Hernia》2017,21(3):335-339
Background
Prevalence, management, and risk of emergency operation for primary ventral or groin hernia in pregnancy are unknown. The objective of this study was to estimate the prevalences of primary ventral or groin hernia in pregnancy and the potential risks for elective and emergency repair.Methods
This single-institutional retrospective study included all pregnant women attending one or more prenatal consultations at Hvidovre Hospital, Denmark, during a 3-year period. Patients’ medical records were electronically retrieved. A free-text search algorithm and subsequent manual review was conducted to identify patients registered with a primary ventral or groin hernia in pregnancy. Follow-up was conducted by review of medical record notes within the Capital Region of Denmark supplemented with structured telephone interviews on indication.Results
In total, 20,714 pregnant women were included in the study cohort. Seventeen (0.08%) and 25 (0.12%) women were registered with a primary ventral and groin hernia, respectively. None underwent elective or emergency repair in pregnancy, and all had uncomplicated childbirth. In 10 women, the groin bulge disappeared spontaneously after delivery. During postpartum follow-up of median 4.4 years (range 0.2–6.0 years), five (0.02%) and four (0.02%) underwent elective primary ventral and groin hernia repair, respectively.Conclusion
Primary ventral or groin hernia seems rare in pregnancy, and the incidence of emergency repair is extremely low. Watchful waiting strategy is recommended during pregnancy in women suspected for a primary ventral or groin hernia.7.
Objective
Anatomic reconstruction of the posterior facet by primary stabilization of the calcaneal fracture with a locking nail.Indications
All intraarticular calcaneal fractures and unstable two-part fractures independent of the degree of closed/open soft tissue trauma.Contraindications
High perioperative risk, soft tissue infection, beak fracture (type II fracture) and still open apophysis.Surgical technique
Anatomic reduction of the posterior facet using a sinus tarsi approach. Reduction and temporary fixation of the sustentacular, tuberosity, and anterior process fragments with 1.8–2.0 mm Kirschner wires. Thereafter, the C-Nail (calcaneus nail) is introduced with its guiding device stabilizing the sustentacular, tuberostity, and anterior process fragments through its three guiding arms with 6 or 7 locking screws.Postoperative management
Passive and active motion starts on postoperative day 2. Lymph drains help reduce swelling. Partial weightbearing with 20 kg for 6–8 weeks in the patient’s own shoes is recommended. X?ray controls are done at 4 and 8 weeks as well as after 6 and 12 months.Results
A total of 107 calcaneal fractures treated with the C-Nail between 2011 and 2014 were evaluated according to the AOFAS score 6 months and 1 year after surgery. The measured values were on average 93.0 (range 65–100) points at 6 months and 94.1 (range 75–100) points 12 months after the surgery. Böhler’s angle with initial traumatic values of 6.2° (?30 to +13°) improved postoperatively to 31.8°, after 3 months slightly decreased to 29.6°, and after 12 months to 28.3°. There were 2 cases of superficial wound necrosis (1.9?%) and 1 case a deep infection (0.93?%) with need of early C-Nail removal.8.
Purpose
Chronic post-operative groin pain is a substantial complication following open mesh inguinal hernia repair. The exact cause of this pain is still unclear, but entrapment or trauma of the ilioinguinal nerve may have a role to play. Elective division of this nerve during hernia repair has been proposed in an attempt to reduce the incidence of chronic groin pain.Methods
We performed a meta-analysis of nine randomized controlled trials comparing preservation versus elective division of the ilioinguinal nerve during this operation.Results
A substantial proportion of patients having open mesh inguinal hernia repair experience chronic groin pain when the ilioinguinal nerve is preserved (estimated rate of 9.4% at 6 months and 4.8% at 1 year). Elective division of the nerve resulted in a significant reduction of groin pain at 6-months post-surgery (RR 0.47, p = 0.02), including moderate/severe pain (RR 0.57, p = 0.01). However, division of the nerve also resulted in an increase of subjective groin numbness at this time point (RR 1.55, p = 0.06). At 12-month post-surgery, the beneficial effect of nerve division on chronic pain was reduced, with no significant difference in the rates of overall groin pain (RR 0.69, p = 0.38), or of moderate-to-severe groin pain (RR 0.99, p = 0.98) between the two groups. The prevalence of groin numbness was also similar between the two groups at 12-month post-surgery (RR 0.79, p = 0.48).Conclusions
Routine elective division of the ilioinguinal nerve during open mesh inguinal hernia repair does not significantly reduce chronic groin pain beyond 6 months, and may result in increased rates of groin numbness, especially in the first 6-months post-surgery.9.
Background
The growing number of bariatric surgery videos shared on YouTube highlights the need for content and quality assessment. The aim of this study was to answer the question ‘Is watching these videos useful to surgeons and patients?’Methods
YouTube was searched using the keywords ‘obesity surgery’, ‘bariatric surgery’ and ‘weight loss surgery’, and 100 videos retrieved using each keyword were classified based on their ‘usefulness score’ as very useful, useful and not useful. Video content; source; length and number of views, likes and dislikes were recorded. Upload sources included doctors or hospitals (DH), medical web sites or TV channels (MW), commercial web sites (CW) or civilians (CI). Between-group differences were compared.Results
Of the 300 videos watched, 175 were included in the study; 53.7% were useful and 24.6% were very useful. There were no between-group differences in the number of likes (p = 0.480), dislikes (p = 0.592) and views (p = 0.104). Most videos were uploaded by MW and DH, also with no significant differences in the number of likes (p = 0.35), dislikes (p = 0.14) and views (p = 0.93). No videos were found with misleading information.Conclusions
The popularity of bariatric surgery and interest of both patients and surgeons are increasing daily. Although videos on bariatric surgery on YouTube may be more useful than those on other surgical procedures, it is important that the videos are uploaded by medical professionals and that specific upload and retrieval filters are applied.10.
Adriana Martini Adriano Ammirati Carlos Garcia Carolina Andrade Odete Portela Maysa S. Cendoroglo Ricardo Sesso 《International urology and nephrology》2018,50(4):725-731
Purpose
The diagnosis of chronic kidney disease (CKD) in elderly individuals has been increasing. The objective of this study was to evaluate physical, mental and social aspects in longevous elderly patients with CKD.Methods
Eighty patients with CKD (stage 4 and 5, not on dialysis) and 60 longevous elderly (≥ 80 years) paired by gender and age living in the community were evaluated. Physical, cognitive, social and quality of life aspects were analyzed according to the following scales: Charlson comorbidity index, Medical Outcomes Study Short Form 36-Item (SF-36), Medical Outcomes Study, Boston Naming Test, verbal fluency test (animal naming), sit-to-stand test, gait speed, and the Mini-Mental state examination.Results
Compared to the control group, the CKD group had a higher mean in the comorbidities index (3.5 ± 1.2 vs. 1.0 ± 1, respectively, p < 0.001). In the multivariate analysis, the CKD group presented worse performance in the SF-36 dimensions: ‘physical functioning,’ ‘general health,’ ‘emotional functioning,’ ‘vitality,’ and physical component summary. On the other hand, they presented better results for the ‘mental health’ dimension, in addition to lower social support, worse verbal fluency and worse results on the sit-to-stand test.Conclusions
Longevous patients with stage 4 or 5 CKD presented worse evaluation in several domains of physical and emotional functioning, lower social support and evidence of worse cognitive performance. These aspects should be taken into account in order to improve the care provided to these patients, improve their quality of life and prevent their morbidity.11.
Purpose
To analyze severe complications after groin hernia repair with respect to age, ASA score, hernia anatomy, method of repair and method of anesthesia, using nationwide registers.Summary background data
The annual rate of 20 million groin hernia operations throughout the world renders severe complications, although rare, important both for the patient, the clinician, and the health economist.Methods
Two nationwide registers, the Swedish Hernia Register and the National Swedish Patient Register were linked to find intraoperative complications, severe cardiovascular events and severe surgical adverse events within 30 days of groin hernia surgery.Results
143,042 patients, 8 % women and 92 % men, were registered between 2002 and 2011. Intraoperative complications occurred in 801 repair, 592 patients suffered from cardiovascular events and 284 patients from a severe surgical event within 30 days of groin hernia surgery. Emergency operation was a risk factor for both cardiovascular and severe surgical adverse events with odds ratios for cardiovascular events of 3.1 (2.5–4.0) for men and 2.8 (1.4–5.5) for women. Regional anesthesia was associated with an increase in cardiovascular morbidity compared with local anesthesia, odds ratio 1.4 (1.1–1.9). In men, bilateral hernia and sliding hernia approximately doubled the risk for severe surgical events; odds ratio 1.9 (1.1–3.5) and 2.2 (1.6–3.0), respectively. Methods other than open anterior mesh repair increased the risk for surgical complications.Conclusions
Awareness of the increased risk for cardiovascular or surgical complications associated with emergency surgery, bilateral hernia, sliding hernia, and regional anesthesia may enable the surgeon to further reduce their incidence.12.
J. P. J. Burgmans C. E. H. Voorbrood T. Van Dalen R. N. Boxhoorn G. J. Clevers F. B. M. Sanders D. B. J. Naafs R. K. J. Simmermacher 《Hernia》2016,20(1):55-62
Purpose
Persistent pain is a known side effect after TEP inguinal repair disabling 2–5 % of patients. A standardized diagnostic work-up so far is not available. MRI is a diagnostic tool in the work-up of inguinal hernias. In the present study the yield of MRI in evaluating chronic pain after TEP hernia repair is addressed.Methods
In our database patients receiving an MRI scan for groin pain lasting more than 3 months after TEP inguinal hernia repair were identified. A checklist with potential pathologic findings was filled out for each groin by two blinded observers. Findings in painful, pain-free and unoperated groins were compared and statistical analysis done based upon their relative incidences. Cohen’s kappa coefficients were calculated to determine interobserver agreement.Results
Imaging studies of 53 patients revealed information regarding 106 groins. Fifty-five groins were painful after the initial operation, 12 were pain-free postoperatively and 39 groins were not operated. None of the predefined disorders was observed statistically more often in the patients with painful groins. Only fibrosis appeared more prevalent in patients with chronic pain (P = 0.11). Interobserver agreement was excellent for identifying the mesh (κ = 0.88) and observing bulging or a hernia (κ = 0.74) and was substantial for detecting fibrosis (κ = 0.63). In 40 % of the patients, MRI showed a correct mesh position and observed nothing else than minor fibrosis. A wait and see policy resolved complaints in the majority of the patients. In 15 % of the patients, MRI revealed treatable findings explanatory for persisting groin pain.Conclusion
For patients with post-TEP hernia groin pain, MRI is useful to confirm a correct flat mesh position and to identify possible not operation-related causes of groin pain. It is of little help to identify a specific cause of groin repair-related pain.13.
14.
T. Pillukat R. Fuhrmann J. Windolf J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(1):47-64
Objective
Bony healing of dislocated distal radius fractures after open reduction and internal stabilization by locking screws/pins using palmar approach.Indications
Extraarticular distal radius fractures type A2/A3, simple extra- and intraarticular fractures type C1 according to the AO classification, provided a palmar approach is possible.Contraindications
Forearm soft tissue lesions/infections. As a single procedure if a volar approach not possible.Surgical technique
Palmar approach to the distal radius and fracture. Open reduction. Palmar fixation of the plate to radial shaft with single screw. After fluoroscopy, distal fragments fixed using locking screws.Postoperative management
Below-the-elbow cast for 2 weeks. Early exercise of thumb and fingers, wrist mobilization after cast removal. Complete healing after 6–8 weeks.Results
Ten patients averaged 100?% range of motion of the unaffected side after 43±21 months. No complications observed. DASH score averaged 12±16 points; Krimmer wrist score was excellent in 7, good in 2, and fair in one.15.
Tatsiana?Khatsilouskaya Tobias?Haltmeier Marionna?Cathomas Barbara?Eberle Daniel?Candinas Beat?Schnüriger
Background
Patients with blunt solid organ injuries (SOI) are at risk for venous thromboembolism (VTE), and VTE prophylaxis is crucial. However, little is known about the safety of early prophylactic administration of heparin in these patients.Methods
This is a retrospective study including adult trauma patients with SOI (liver, spleen, kidney) undergoing non-operative management (NOM) from 01/01/2009 to 31/12/2014. Three groups were distinguished: prophylactic heparin (low molecular weight heparin or low-dose unfractionated heparin) ≤72 h after admission (‘early heparin group’), >72 h after admission (‘late heparin group’), and no heparin (‘no heparin group’). Patient and injury characteristics, transfusion requirements, and outcomes (failed NOM, VTE, and mortality) were compared between the three groups.Results
Overall, 179 patients were included; 44.7% in the ‘early heparin group,’ 34.6% in the ‘late heparin group,’ and 20.8% in the ‘no heparin group.’ In the ‘late heparin group,’ the ISS was significantly higher than in the ‘early’ and ‘no heparin groups’ (median 29.0 vs. 17.0 vs. 19.0; p < 0.001). The overall NOM failure rate was 3.9%. Failed NOM was significantly more frequent in the ‘no heparin group’ compared to the ‘early’ and ‘late heparin groups’ (10.8 vs. 3.2 vs. 1.3%; p = 0.043). In the ‘early heparin group’ 27.5% patients suffered from a high-grade SOI; none of these patients failed NOM. Mortality did not differ significantly. Although not statistically significant, VTE were more frequent in the ‘no heparin group’ compared to the ‘early’ and ‘late heparin groups’ (10.8 vs. 4.8 vs. 1.3%; p = 0.066).Conclusion
In patients with SOI, heparin was administered early in a high percentage of patients and was not associated with an increased NOM failure rate or higher in-hospital mortality.16.
K.-H. Frosch R. Akoto T. Drenck M. Heitmann C. Pahl A. Preiss 《Operative Orthopadie und Traumatologie》2016,28(3):193-203
Objective
An arthroscopic technique for the reconstruction of the posterolateral corner combined with posterior cruciate ligament (PCL) reconstruction was developed.Indications
Posterolateral rotational instabilities of the knee. Combined lesions of the PCL, the popliteus complex (PLT) and the posterolateral corner. Isolated PLT lesions lacking static stabilizing function.Contraindications
Neuromuscular disorders; knee deformities or fractures; severe posterolateral soft tissue damage.Surgical technique
Six arthroscopic portals are necessary. Using the posteromedial portal, resect dorsal septum with a shaver. Visualize the PCL, the lateral femoral condyle and the posterolateral recessus with the PLT. Dissect the popliteomeniscal fibers; retract PLT until sulcus popliteus is visualized. Drill a 6-mm tunnel anteriorly into the distal third of the sulcus popliteus. Visualize femoral footprint of the PLT and place an anatomical drill tunnel. Pull the popliteus bypass graft into the knee and fix with bioscrews. Fix the reconstructed PCL. In cases of additional LCL injury, reconstruct LCL with autologous graft.Postoperative management
Partial weight-bearing for 6 weeks, range of motion exercises, quadriceps-strengthening exercises on postoperative day 1. Full extension allowed immediately with flexion limited to 20° for 2 weeks, to 45° for up to week 4, and to 60° up to week 6. Use a PCL brace for 3 months, running and squatting exercises allowed after 3 months.Results
In the 35 patients treated, no technique-related complications. After 1 year, 12 patients had a mean Lysholm Score of 88.6 (± 8.7) points and a side-to-side difference in the posterior drawer test of 2.9 (± 2.2) mm (preoperative 13.3 [± 1.9] mm).Conclusion
Low complication risk and good and excellent clinical results after arthroscopic posterolateral corner reconstruction.17.
Matthew M. Smith William G. Young Arthur M. Carlin Tamer A. Ghanem 《Journal of robotic surgery》2016,10(1):73-75
Background
The pyriform sinus is a potential location for ectopic parathyroid tissue and we describe the use of trans-oral robotic to excise the ectopic tissue.Methods
A 55-year-old female presented with primary hyperparathyroidism. 4D computed tomography and Sestimibi scan revealed a 1.2 × 0.7 cm mass in the left pyriform sinus. Using the da Vinci SI robot, a 1 cm hypopharyngeal incision was made with electrocautery in the left pyriform sinus and used to excise the mass.Results
Ectopic mass was removed via trans-oral robotic approach and final pathology confirmed parathyroid tissue. Parathyroid hormone level dropped from 135.8 to 13.3 pg/ml 15 min after excision of the mass.Conclusion
Ectopic parathyroid tissue can present in many different areas of the neck, with the pyriform sinus being a potential location. The trans-oral robotic parathyroidectomy confers the advantage of the lack of an external incision for removal of ectopic parathyroid adenoma.18.
Objective
To evaluate iliopsoas atrophy and loss of function after displaced lesser trochanter fracture of the hip.Design
Cohort study.Setting
District hospital.Patients
Twenty consecutive patients with pertrochanteric fracture and displacement of the lesser trochanter of?>?20 mm.Intervention
Fracture fixation with either an intramedullary nail or a plate.Outcome measurements
Clinical scores (Harris hip, WOMAC), hip flexion strength measurements, and magnetic resonance imaging findings.Results
Compared with the contralateral non-operated side, the affected side showed no difference in hip flexion force in the supine upright neutral position and at 30° of flexion (205.4 N vs 221.7 N and 178.9 N vs. 192.1 N at 0° and 30° flexion, respectively). However, the affected side showed a significantly greater degree of fatty infiltration compared with the contralateral side (global fatty degeneration index 1.085 vs 0.784), predominantly within the psoas and iliacus muscles.Conclusion
Severe displacement of the lesser trochanter (>?20 mm) in pertrochanteric fractures did not reduce hip flexion strength compared with the contralateral side. Displacement of the lesser trochanter in such cases can lead to fatty infiltration of the iliopsoas muscle unit. The amount of displacement of the lesser trochanter did not affect the degree of fatty infiltration.Level of evidence
II.19.
Joon-Hyop Lee Young Jun Chai Tae-Hyung Kim June Young Choi Kyu Eun Lee Hyun-Young Kim Yoo-Seok Yoon Hyeon Hoe Kim 《World journal of surgery》2016,40(12):2970-2975
Background
Ganglioneuromas are benign tumors that rarely develop from adrenal glands. In this study, we present our clinical experience of patients with adrenal ganglioneuroma (AGN).Methods
Demographic, diagnostic, surgical, and pathologic findings of patients who were adrenalectomized as a result of AGN were retrospectively reviewed from the database of a tertiary referral hospital.Results
Among 1784 patients who underwent an adrenalectomy between 2002 and 2015, 35 (1.9 %; 14 males, 21 females) were diagnosed with AGN. Mean age was 33.4 ± 18.7 years (0–84). Twenty-nine (82.9 %) were asymptomatic, four (11.4 %) complained of abdominal discomfort, and two (5.7 %) had abdominal distension. Preoperative computed tomography (CT) reported AGN in 22 (62.9 %) cases. Precontrast Hounsfield units, increased postcontrast phase attenuation, and well-defined borders were characteristic CT features of AGN. Mean tumor size was 6.3 ± 3.3 cm (range, 1.5–16.0). No recurrence occurred during a median follow-up period of 19 months (range, 1–120).Conclusion
AGN was asymptomatic in most cases and diagnosis may be challenging. Adrenalectomy is a safe treatment modality for AGN and ensures favorable outcomes when diagnosed.20.
Rodrigo Ruano Adnan Safdar Jason Au Chester J. Koh Patricio Gargollo Alireza A. Shamshirsaz Jimmy Espinoza Darrell L. Cass Oluyinka O. Olutoye Olutoyin A. Olutoye Stephen Welty David R. Roth Michael A. Belfort Michael C. Braun 《Pediatric nephrology (Berlin, Germany)》2016,31(4):605-612