The modified Nyhus–Condon femoral hernia repair

Purpose  

When encountered, a femoral hernia requires repair due to its propensity for incarceration with associated morbidity and mortality. Several operations have been described, including the low approach (Lockwood), the high approach (Lotheisen) and McEvedy’s preperitoneal approach. Recently, laparoscopic repair has also been advocated. The Nyhus–Condon repair, a transverse abdominal preperitoneal repair, was first employed in 1943 and has been widely used since. The aim of this study was to describe our modification of the Nyhus–Condon repair.     

Single Incision (“Scarless”) Laparoscopic Total Abdominal Colectomy with End Ileostomy for Ulcerative Colitis

Introduction  

Total abdominal colectomy with ileal pouch–anal anastomosis is the intervention of choice for patients with medically uncontrolled ulcerative colitis. A three-stage approach is preferred in particularly debilitated patients. In this setting, laparoscopic surgery has shown to be safe, offering several advantages over the open approach. Single incision laparoscopic surgery is a new minimally invasive approach which represents a true scarless procedure for the first step of the restorative proctocolectomy. In this article, we describe our technique in performing the single-incision total abdominal colectomy.     

Minimally invasive Ivor–Lewis esophagogastrectomy for gastric cardia cancer

Introduction  

Gastric cardia cancer with involvement of the esophagus may require an esophagogastrectomy to obtain negative tumor margins. Multiple studies have shown that minimally invasive esophagectomy is a safe approach for the treatment of esophageal cancer [1–3]. We describe the technique of a minimally invasive Ivor–Lewis esophagectomy in a 55-year-old patient with a gastric cardia tumor.     

Open Abdomen Treatment with Dynamic Sutures and Topical Negative Pressure Resulting in a High Primary Fascia Closure Rate

Background

Open abdomen (OA) treatment with negative-pressure therapy is a novel treatment option for a variety of abdominal conditions. We here present a cohort of 160 consecutive OA patients treated with negative pressure and a modified adaptation technique for dynamic retention sutures.

Methods

From May 2005 to October 2010, a total of 160 patients—58 women (36?%); median age 66?years (21–88?years); median Mannheim peritonitis index 25 (5–43) underwent emergent laparotomy for diverse abdominal conditions (abdominal sepsis 78?%, ischemia 16?%, other 6?%).

Results

Hospital mortality was 21?% (13?% died during OA treatment); delayed primary fascia closure was 76?% in the intent-to-treat population and 87?% in surviving patients. Six patients required reoperation for abdominal abscess and five patients for anastomotic leakage; enteric fistulas were observed in five (3?%) patients. In a multivariate analysis, factors correlating significantly with high fascia closure rate were limited surgery at the emergency operation and a Bj?rk index of 1 or 2; factors correlating significantly with low fascia closure rate were male sex and generalized peritonitis.

Conclusions

With the aid of initially placed dynamic retention sutures, OA treatment with negative pressure results in high rates of delayed primary fascia closure. OA therapy with the technical modifications described is thus considered a suitable treatment option in various abdominal emergencies.     

Adequate debridement and drainage of the mediastinum using open thoracotomy or video-assisted thoracoscopic surgery for Boerhaave's syndrome

Background  

Boerhaave’s syndrome has a high mortality rate (14–40%). Surgical treatment varies from a minimal approach consisting of adequate debridement with drainage of the mediastinum and pleural cavity to esophageal resection. This study compared the results between a previously preferred open minimal approach and a video-assisted thoracoscopic surgery (VATS) procedure currently considered the method of choice.     

Giant hydronephrosis mimicking progressive malignancy

Background  

Cases of giant hydronephroses are rare and usually contain no more than 1–2 litres of fluid in the collecting system. We report a remarkable case of giant hydronephrosis mimicking a progressive malignant abdominal tumour.     

Harrahill’s technique: a simple screening test for intra-abdominal pressure measurement

Background  

Repair of giant incisional hernias may lead to an increase in intra-abdominal pressure (IAP) and, sometimes, to abdominal compartment syndrome. Measurement of IAP using Kron’s technique (Kron et al. in Ann Surg 199:28–30, 1984) is currently accepted as the gold standard, whereas Harrahill has described a simple measurement setup using urinary drainage manometry (Harrahill in J Emerg Nurs 24:465–466, 1998). The aim of this clinical trail was to evaluate the correlation, reproducibility and effectiveness of this device.     

Reoperative Transaxillary Breast Surgery: Using the Axillary Incision to Treat Augmentation-related Complications

Background  

The axillary incision for breast augmentation has been an option for patients and surgeons for more than 30 years now. Controlled clinical trials have demonstrated that reoperations continue to be significant (15–24% at 3 years) independent of incision choice. The misbelief that the transaxillary approach is not adequate for reoperations inhibits patients’ and surgeons’ decisions on what incision is best in each case.     

Comparison of ultrasonography and physical examination in the diagnosis of incisional hernia in a prospective study

Purpose  

Incisional hernia is a frequent complication of abdominal surgery (incidence 2–20%). Diagnosis by physical examination is sometimes difficult, especially in small incisional hernias or in obese patients. The additional diagnostic value of standardized ultrasonography was evaluated in this prospective study.     

Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon)

Background  

Idiopathic sclerosing encapsulating peritonitis (or abdominal cocoon) is a rare cause of small bowel obstruction, especially in adult population. Diagnosis is usually incidental at laparotomy. We discuss one such rare case, outlining the fact that an intra-operative surprise diagnosis could have been facilitated by previous investigations.     

Staged lavage versus single high-volume lavage in the treatment of feculent/purulent peritonitis: a matched pair analysis

Background  Spontaneous and iatrogenic secondary peritonitis remain to have a mortality of 10–30% and significant socioeconomic impact in survivors and especially non-survivors. Data on the most cost-effective treatment are lacking. We therefore studied outcome and resource utilization in a homogeneous cohort of patients with secondary fecal or purulent peritonitis undergoing surgery with source control and two different types of abdominal lavage. Methods  Thirty-one consecutive patients with secondary feculent or purulent peritonitis of the lower gastrointestinal tract underwent a single high-volume lavage. That cohort was matched with 31 patients with the same source, extent, and quality of peritonitis treated by source control and staged lavage (intermittent lavage). Results  Patients in both groups were comparable in gender distribution, age, comorbidity, source, extent, and severity of peritonitis with the history of intestinal perforation in the single high-volume lavage group being significantly higher than in the intermittent lavage group (2.0 ± 1.7 vs. 1.1 ± 0.8d; p = 0.008). Patients in the single high-volume lavage group had significantly less operations, thus requiring significantly less operation time (OR-time), intensive care unit (ICU)-requirement, ventilatory support, and inotropic support. Conclusion  Patients with secondary fecal or purulent peritonitis in at least two quadrants, undergoing a one step surgical repair including source control, primary anastomosis, and single high-volume lavage with more than 25 l have a comparable outcome to patients treated by staged lavage at significantly lower OR and ICU-utilization.     

Immune mediators of postoperative ileus

Clinical background  

In all patients undergoing abdominal surgery, a transient phase of interruption of bowel motility, named postoperative ileus (POI) occurs. POI is often accepted as an unavoidable “physiological” response and a self-limiting complication after surgery although it has a significant impact on patient morbidity with prolonged hospitalization and increased costs. Annual economic burden has been estimated as much as US $1.47 billion in the USA (Iyer et al. in J Manag Care Pharm 15(6):485–494, 2009).     

Biomechanics of the front abdominal wall as a potential factor leading to recurrence with laparoscopic ventral hernia repair

Background  

Intraabdominal pressure often is blamed as the cause of mesh–fascia junction failure after laparoscopic ventral hernia repair. Stretching of the mesh during a cough or defecation may lead to recurrence. Little is known about the movements of mesh in the abdominal cavity after this operation. This study investigated the front abdominal wall to describe its elasticity in vivo and searched for elongations that possibly stretched an implanted mesh, thereby causing fixation failure and subsequent recurrence.     

Augmentation–Mastopexy Using an Autologous Parenchymal Sling

Background  

Mastopexy–augmentation is an important treatment to address breast deflation. Combining these two procedures is technique-sensitive, with a reported high revision rate and propensity for complications. We describe an approach to achieve aesthetic breast correction in an effective, reproducible, and safe manner while minimizing untoward sequela.     

Sternal wound infection following open heart surgery: appraisal of incidence,risk factors,changing bacteriologic pattern and treatment outcome

Background  

The incidence of Sternal wound infection as reported worldwide is 0.43–2.3% [1–7]. The incidence is low and has serious effects on the patients in terms of the morbidity, hospital stay, cost as well as mortality. This study proposes to identify the risk factors, changing bacteriologic and the treatment outcomes.     

Intussusception in adult and pediatric patients: Two different entities

Purpose  

Intussusception is one of the most common abdominal emergencies in pediatrics, but adult intussusception is an uncommon entity and most surgeons have only limited experience in treating this disease. The purpose of this study was to highlight the differences between pediatric and adult intussusception.     

Therapy of hypoparathyroidism with intact parathyroid hormone

Summary  

Hypoparathyroidism, a disorder characterized by low parathyroid hormone (PTH), is generally treated with oral calcium and vitamin D supplementation. We investigated the effects of PTH(1–84) treatment in 30 hypoparathyroid subjects for 24 months. PTH(1–84) treatment in hypoparathyroidism significantly reduced supplemental calcium and 1,25-dihydroxyvitamin D requirements without generally altering serum and urinary calcium levels.     

Hepatic trauma management and outcome; Our experience

Background  

Injuries to the liver have been reported in 35–45% of patients with significant blunt abdominal trauma. Since the introduction of ultrasonography and computerized tomography in the evaluation of these patients, there has been an increase in number of hepatic injuries diagnosed that previously would not have been apparent.     

Delayed primary closure of the septic open abdomen with a dynamic closure system

Background  

The major challenge in the management of patients with an infected open abdomen (OA) is to control septic peritonitis and intra-abdominal fluid secretion, and to facilitate repeated abdominal exploration, while preserving the fascia for delayed primary closure. We here present a novel method for closure of the infected OA, based on continuous dynamic tension, in order to achieve re-approximation of the fascial edges of the abdominal wall.     

The effect of PTH(1�C84) or strontium ranelate on bone formation markers in postmenopausal women with primary osteoporosis: results of a randomized, open-label clinical trial

Summary  

We explored the effects of PTH(1–84) compared with strontium ranelate on bone remodeling as measured by bone remodeling markers in postmenopausal women with osteoporosis. Biochemical markers of bone formation were significantly increased after treatment with PTH(1–84) but not strontium ranelate, indicating a different mechanism of action between these agents.