Lumbar incisional hernias are difficult to repair because one of the hernia margins is bone, namely, the iliac crest. Previous studies have described the use of orthopedic bone anchors that fix a ...mesh onto the iliac crest. We present a novel technique for open repair of large lumbar incisional hernias using a double-mesh technique in combination with suture-loaded bone anchors to reattach the abdominal wall musculature onto the iliac crest. The surgical technique involves creating a preperitoneal plane behind the transversus abdominus and above the iliac crest and iliacus, below the iliac crest, with application of a Prolene mesh in this layer. This is followed by the drilling of suture-loaded Christmas Tree bone anchors™ along the rim of the iliac crest. The preloaded sutures are used to attach the myofascial component on the iliac crest, followed by the placement of a second Prolene mesh in an on-lay fashion. Drains are left in the preperitoneal and subcutaneous spaces. Unlike other reported techniques in the literature which only fix mesh onto the iliac crest, our technique with the use of Christmas Tree bone anchors™ allows for complete reconstruction of the lumbar abdominal wall defect and its myofascial components.
The trend toward minimally invasive procedures (MIP) in necrotizing pancreatitis is increasing. The optimal timing and technique of cholecystectomy in severe/necrotizing pancreatitis is unclear. This ...study aims to determine the role of laparoscopic cholecystectomy after severe/necrotizing pancreatitis in the context of MIP.
Retrospective analysis of a prospective database was performed for consecutive patients after cholecystectomy for gallstone pancreatitis between January 2011 and January 2018 at Monash Health, Melbourne, Australia.
Three hundred fifty-five patients with gallstone pancreatitis underwent laparoscopic cholecystectomy with 2 conversions. Patients with severe pancreatitis were older (P = 0.002), with a more even sex distribution when compared with mild pancreatitis. Females predominated in the mild pancreatitis group.Patients with moderate/severe pancreatitis (P = 0.002) and necrosis (P > 0.001) were more likely to have delayed cholecystectomy compared with mild pancreatitis. There was no increase in biliary presentations while awaiting cholecystectomy. Length of stay for patients with severe/necrotizing pancreatitis (P = 0.001) was increased, surgical complications appeared similar.
Laparoscopic cholecystectomy can be performed safely and effectively for pancreatitis, irrespective of severity. The paradigm shift in the management of severe necrotizing pancreatitis away from open necrosectomy toward MIP can be extended to encompass laparoscopic cholecystectomy.
Type VI choledochal cyst: a rare entity Ackermann, Travis; Spilias, Dean
ANZ journal of surgery,
December 2020, 2020-12-00, 20201201, Letnik:
90, Številka:
12
Journal Article
Introduction
Primary endoscopic and percutaneous drainage for pancreatic necrotic collections is increasingly used. We aim to compare the relative effectiveness of both modalities in reducing the ...duration and severity of illness by measuring their effects on systemic inflammatory response syndrome (SIRS).
Methods
We retrospectively reviewed all cases of endoscopic and percutaneous drainage for pancreatic necrotic collections performed in 2011–2016 at two hospitals. We assessed the post‐procedure length of hospital stay, reduction in C‐reactive protein levels, resolution of SIRS, the complication rates, and the number of procedures required for resolution.
Results
Thirty‐two patients were identified and 57 cases (36 endoscopic, 21 percutaneous) were included. There was no significant difference in C‐reactive protein reduction between endoscopic and percutaneous drainage (69.5% vs 68.8%, P = 0.224). Resolution of SIRS was defined as the post‐procedure normalization of white cell count (endoscopic vs percutaneous: 70.4% vs 64.3%, P = 0.477), temperature (endoscopic vs percutaneous: 93.3% vs 60.0%, P = 0.064), heart rate (endoscopic vs percutaneous: 56.0% vs 11.1%, P = 0.0234), and respiratory rate (endoscopic vs percutaneous: 83.3% vs 0.0%, P = 0.00339). Post‐procedure length of hospital stay was 27 days with endoscopic drainage and 46 days with percutaneous drainage (P = 0.0183).
Conclusion
Endoscopic drainage was associated with a shorter post‐procedure length of hospital stay and a greater rate of normalization of SIRS parameters than percutaneous drainage, although only the effects on heart rate and respiratory rate reached statistical significance. Further studies are needed to establish which primary drainage modality is superior for pancreatic necrotic collections.
This is a first reported case of isolated retroperitoneal mesothelioma. Most patients present with symptoms of abdominal pain, distension and weight loss. However, a minority of cases are ...asymptomatic and are found incidentally on imaging. It is important to provide an early histological diagnosis to help with management and prognostication.
We present a male patient who was referred to our surgical clinic with an incidental finding of an indeterminate retroperitoneal lesion. The patient underwent numerous investigations without further clarity of the lesion. A 5 cm lobulated cystic lesion was excised in the retroperitoneum and found to be loosely adherent but separate to the duodenum, inferior vena cava and right adrenal gland. Histopathology revealed a localised multinodular epithelioid mesothelioma. The patient was referred to a specialist cancer centre and has remained well on subsequent follow-up.
Although multiple reports of lung, liver and kidney mesotheliomas are described, to our knowledge this is the first report of isolated retroperitoneal mesothelioma. Diagnosis of peritoneal mesothelioma is diagnostically challenging as there are no features on imaging characteristic for peritoneal mesothelioma. Hence, tumour markers and magnetic resonance imaging should be used in conjunction. The prognosis of mesothelioma is dependent on the patients' histopathology, where diffuse mesothelioma poses a worse prognosis than localised mesothelioma. Modern therapies for diffuse mesothelioma now include cytoreduction surgery (CRS) and hyperthermic intraoperative peritoneal perfusion with chemotherapy (HIPEC).
An excisional biopsy may be warranted for indeterminate lesions with a high degree of suspicion for malignancy.
•This is a first reported case of retroperitoneal mesothelioma.•Majority of patients with peritoneal mesothelioma present with abdominal pain, distension and weight loss.•Mesothelioma requires multiple imaging modalities with the assistance of tumour markers to diagnose.•Excisional biopsy may be warranted for indeterminate lesions, with a high degree of suspicion for malignancy.
