Cosmetic improvement of testicular prostheses for children

A new testicular prosthesis for pediatric use is presented. This differs from the model usually available in that it is pink-pigmented and opaque. Over a period of 2 years and 6 months, 57 testicular prostheses were implanted in 53 boys. Seventeen of these were opaque, pigmented ones, while the others were regular translucent prostheses. No complications occurred with either type. Even when applied in adults, the traditional translucent prosthesis gives the unpleasent impression of hydrocele. In pediatric cases, this unesthetic appearance is enhanced because of the disproportion between the scrotum and the size of the prosthesis. The cosmetic appearances of these scrota have been partially improved by the use of colored, opaque prostheses. Offprint requests to: F. Ferro     

Laparoscopic incisional lumbar hernia repair

Purpose  Incisional lumbar hernia is an uncommon hernia type. Open surgical procedures have significant postoperative morbidity and patient dissatisfaction, therefore, for the repair of seven incisional lumbar hernias, we attempted using an intraperitoneal laparoscopic technique that was described to have good short-term results and decreased morbidity. Methods  We applied a laparoscopic technique using polypropylene meshes in five patients and composite meshes in two patients to cover the defect, then placed prolene sutures and hernia staples to secure the mesh intraperitoneally. Result  The technique was successful in all patients, and they tolerated the procedure well. All did well after surgery, ambulating and eating a regular diet on postoperative day 1. No postoperative complications developed. At a mean follow-up of 34.1 months (range 17–43 months) none of them had pain, mass, or evidence of recurrence, and furthermore, cosmesis was excellent. Conclusions  We believe that the laparoscopic approach is feasible, safe, and the least invasive choice for repairing difficult hernias such as incisional lumbar hernias.     

Oncoplastic surgery after mammary reduction and mastopexy for bilateral breast cancer lesions: Report of a case

We report a case of bilateral breast cancer lesions treated successfully by partial oncoplastic surgery. A 46-year-old Japanese woman presented with a small mass in the right breast. Mammography showed neither a mass nor calcification in the right breast; however, an irregular-shaped mass lesion was shown in the left breast. Ultrasonography and fine-needle aspiration biopsy revealed ductal carcinoma in situ in the inner-upper quadrant of the right breast and invasive ductal carcinoma in the outer-upper quadrant of the left breast. We considered that it would be difficult to obtain a good symmetrical outcome after partial mastectomy for the bilateral breast lesions because of the asymmetrical location of each lesion and her ptotic breasts. Thus, we performed bilateral partial resection, followed by an inferior pedicle reduction mammaplasty-type operation, with and without axillary lymphadenectomy, and achieved good cosmetic and oncologic results.     

Circumumbilical pyloromyotomy in the era of minimally invasive surgery

Background/purpose

No studies have investigated the cosmetic outcome of current approaches to pyloromyotomy in infants with hypertrophic pyloric stenosis. The purpose of this study was to evaluate the final appearance of the scar in patients undergoing circumumbilical pyloromyotomy.

Methods

During a 16-year period, 86 infants underwent circumumbilical pyloromyotomy at our institution. A detailed questionnaire was created to document the family members' perceptions of the esthetic appearance of the scar. Data were collected by telephone interview and at clinic visit. In addition, cosmesis was assessed by 5 staff members who scored blindly the esthetic outcome of the scars with comparative photographs, using a categorical scale.

Results

Fifty-seven families were tracked by telephone contact. In the family questionnaire, 100% of families reported an excellent or good scar. Of these, forty-one (72%) were available for cosmetic assessment. Follow-up ranged between 5 months and 15 years (mean, 6 years). The panel members ranked the scar, on average, as excellent or good for 90% of the patients. No assessor stated that a scar was unacceptable. Intra- and interobserver agreement was 0.72 and 0.78, respectively.

Conclusions

Overall satisfaction with the cosmetic outcome of circumumbilical pyloromyotomy is very high.     

Laparoscopic cholecystectomy utilizing two ports

Laparoscopic cholecystectomy is usually performed via four to five cannulas; a few surgeons employing only three. A technique utilizing two entry ports, an infraumbilical Hasson 10 mm and a medial subcostal 5 mm, is described. The operation was feasible in six of seven patients. In the seventh, a third cannula was placed to allow traction on a floppy gallbladder. No complications ensued and all patients went home the day following operation. While cosmesis was impressive, the patients appeared to experience pain similar to that of patients in whom more cannulas were employed.     

Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn's disease

Background: The objectives of this study were to evaluate body image, cosmetic results, and quality of life in patients with Crohn's disease of the terminal ileum who had either laparoscopic-assisted or open ileocolic resection, and to determine how patients experienced the pre- and postoperative periods after both procedures. Methods: Thirty-four patients participated: 11 patients after open resection (OR), 11 patients after laparoscopic-assisted resection (LR), and 12 patients without resection (WR). Retrospectively, the patients filled out several questionnaires pertaining to body image, hospital experiences, and quality of life. One-way analysis of variance, Student's t-tests, and Pearson's correlation were used for statistical analysis. Results: The cosmetic score was significantly higher in the LR than in the OR group (p < 0.01). Body image correlated strongly with cosmesis and with quality of life. The hospital experiences of the laparoscopic and open groups were similar. Conclusions: Laparoscopic surgery was associated with better cosmesis than open surgery. Patients do not experience laparoscopic surgery any differently from open surgery. Received: 29 September 1997/Accepted: 21 January 1998     

Surgical Management of Heavy Eye Phenomenon

Heavy eye phenomenon can be cosmetically unaccepted due to significant pseudoproptosis and hypotropia. We highlight the salient features of this condition, and report successful cosmetic outcome following a staged procedure comprising orbital decompression and horizontal recti surgery.