Laparoscopic treatment of inguinal hernia

It is always important to treat conditions which may be cancerous with respect and, where there is suspicion, to take biopsies for histological examination. A hoarse voice may, in addition, be a sign of tuberculosis of the larynx, and the clinical appearance can be similar to a carcinoma. Preoperative chest x-ray (not always performed) and an awareness by the histologist of such a possibility are important now that this condition is increasing in frequency in parallel with conditions where immunological status is compromised.     

Laparoscopic treatment of a diaphragmatic hernia through the foramen of Morgagni in children. A case report and review of eleven cases reported in the adult literature

A new case report of laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni in a 11-year-old boy with Down's syndrome is described. The review of 11 other cases in the adult literature illustrated the various aspects of this laparoscopic approach.     

Too old for a lumbar hernia operation

The use of non-cemented prosthetic components in implant surgery is demanding a high quality of bone beds in order to allow for a good level of osseointegration. Two parameters are significant in the evaluation of the quality of the host bone: roughness, which reports on the presence of gaps and peeks, and flatness, which reports on the total percentage of bone which lies in a given interval from the prosthesis. Robot assisted cutting of 32 pig femours and tibiae was performed using various techniques and options. This paper demonstrates roughness and flatness can be taken of the order of the limits necessary for osseointegration, by using a milling cutting tool mounted on a strong support, in this case a robot arm, improving on the results obtained by similar studies referred to hand sawed bones by 10 times.     

Laparoscopic ventral hernia repair: a community hospital experience

OBJECTIVE: To study the suitable age for intraocular lens (IOL) implantation in children. METHODS: 240 (240 eyes) normal children aged 3-13 years old were selected. Their corneal refraction, anterior chamber depth, lens thickness and ocular axial length were measured with Roden-Stock Keratometer C-MES and Eyescan Model 55 separately. RESULTS: The corneal refraction of 3-year-old children, the anterior chamber depth and lens thickness after 5 years old, and the ocular axial length after 9 years old approach the adult magnitude. CONCLUSIONS: A 3-year-old child has been qualified with IOL implantation, the child younger than 9 years old should be implanted with a normal adult IOL and then corrected with glasses, and a child after 10 years old should be directly implanted with a proper dioptric IOL.     

Laparoscopic repair of a paraesophageal hiatal hernia with gastric volvulus

We report the case of a massive paraesophageal hiatal hernia with gastric volvulus which presented with the symptom of a precordial sense of pressure for over two years, which was successfully treated with laparoscopic surgery. The patient is presently in good condition, without any recurrence of either the hiatal hernia or other symptoms one year after surgery. This approach is considered to be a safe and effective procedure, and it also provides for rapid recovery from the operation.     

Laparoscopic repair and groin hernia surgery

Over the past 15 years, laparoscopic herniorrhaphy has made the transition from an experimental to a proven procedure. With increasing laparoscopic skills in the surgical community, many surgeons are now faced with the question of when to recommend laparoscopic herniorrhaphy to their patients. A surgeon's best hernia repair is the one with which they have had the greatest experience. This results in the lowest recurrence and complication rate in his or her hands. Certainly, simple, unilateral hernias and bilateral hernias can be repaired with either anterior or laparoscopic techniques. Many times, laparoscopic herniorrhaphy is too much surgery for a young patient with a unilateral hernia. In such a case, repair is best performed with the patient under local anesthesia. Also, young patients in whom it is advantageous to avoid mesh should not undergo laparoscopic herniorrhaphy. The authors prefer laparoscopic TEP herniorrhaphy in patients with recurrent hernias, bilateral hernias, and unilateral hernias with a suspected contralateral hernia. There is also a consensus that patients with multiple recurrent hernias in whom a preperitoneal repair is appropriate are best served with a laparoscopic repair. Surgeons without advanced laparoscopic skills or without the time to develop the skills necessary to perform laparoscopic herniorrhaphy should consider referring patients with recurrent hernias to surgeons with experience in TEP. TEP is preferable to TAPP because of its lower complication and recurrence rates and in the authors' hands is the "best repair." TAPP should be reserved for patients with prior lower abdominal wall incisions that make the dissection of the peritoneum from the underside of the incision impossible. Patients who cannot tolerate general anesthesia or who have had extensive lower abdominal surgery should not undergo laparoscopic herniorrhaphy. Complication and recurrence rates, although initially higher than traditional repairs, have now fallen to equal or lower levels at centers experienced in laparoscopic techniques. Prospective randomized trials prove that when patients are selected properly and surgeons are adequately trained and proctored, laparoscopic herniorrhaphy can be performed with acceptably low incidences of recurrence and complications.     

Laparoscopic herniotomy in recurrent inguinal hernia

We present a material of 103 patients with a total of 105 recurrent inguinal hernias operated by transabdominal laparoscopic repair. Nine patients developed seromas. One was reoperated due to ileus and one had the mesh removed because of persistent pain in the groin. Following a median observation of 12 months (range 4-48 months) 102 patients were examined and two new recurrences were detected corresponding to 1.9% (95% confidence limits 0.2-6.7%).     

Laparoscopic paraesophageal hernia repair with Nissen fundoplication

Laparoscopic approach to paraesophageal hernia repair is a recent application of minimally invasive videoscopic surgery. Procedures such as paraesophageal hernia repair with Nissen fundoplication that previously could only be performed as open techniques now can be performed laparoscopically. Laparoscopic approach of this major surgical repair benefits patients because of the reduced surgical time, decreased length of hospital stay, reduced hospital costs, and a reduction in loss of work time.     

Laparoscopic hernia repair: a prospective comparison of TAPP and IPOM techniques

AIMS: To investigate changes in morphology of the developmental stages of Enterocytozoon bieneusi and symptomatic relief observed in AIDS patients after treatment with furazolidone. METHODS: Six AIDS patients with symptomatic E bieneusi infection of the small intestine were treated with a course of furazolidone. All patients had a weekly monitoring of parasite shedding in stool by light microscopy during and after treatment. At the end of the treatment, duodenal biopsy specimens obtained from three patients were studied by transmission electron microscopy by two pathologists who were unaware of the patients' treatment. RESULTS: All patients showed both clinical and parasitological response with transient clearance or decrease of spore shedding in stool. After treatment, alterations in faecal spores were observed in all patients by light microscopy, and ultrastructural changes in E bieneusi at all stages of the life cycle were demonstrated in biopsy specimens of the three patients who underwent post-treatment endoscopy. CONCLUSIONS: The clinical benefit seen after treatment with furazolidone in six AIDS patients with E bieneusi intestinal infection may be due to damage to the developmental stages causing a partial inhibition to reproduction of the parasite.     

Laparoscopic hernia surgery--status of minimal invasive techniques in a spectrum of surgical indications

Endoscopic surgery led in the nineties to a discussion on surgical treatment of hernias. At the present time there are three groups of operative procedures: the conventional procedure--Shouldice, Bassini--the open tension-free procedure with implantation of a mesh--Lichtenstein, Gilbert-Rutkow--and the endoscopic procedure (predominantly transabdominal preperitoneal hernioplasty (TAPP) and total extraperitoneal hernioplasty (TEP)). The debate on the optimal therapy of hernias is understandable in view of the large number of hernia operations which are carried out. Numerous studies, some randomized, have demonstrated both the advantages and the disadvantages of the individual operative procedures. In addition to the recurrence rate and the complications, the cost factor and the associated socio-economic aspects of the particular operation play an increasingly important role in the decision on the method that should be used. In December 1995 some Austrian surgeons, who concerned themselves with problems of hernia repair already before the definitive introduction of laparoscopic hernia repair in today's surgery, came together on the occasion of a "Consensus Conference". During the meeting a summary of all relevant aspects of the complex of problems was worked out and summarized in a catalog of indications for the different operative interventions. The main statement was that the traditional open surgery, which can be performed under local anesthesia is indicated for an unilateral primary hernia. In case of an unclear finding at the contralateral side, as well as in case of a recurrent hernia, an endoscopic procedure is indicated. Meanwhile the Hernia Forum of Zürs ("Zürser Hernienforum") was founded. The function of this forum is the realization of a prospective randomized study for hernia repair in Austria.     

Laparoscopic transperitoneal versus extraperitoneal inguinal hernia repair: a prospective clinical trial

Myoporum laetum was collected in the municipalities of Rio Grande and Capao do Leao in winter and in Santa Vitoria in summer, autumn, winter and spring, in the state of Rio Grande do Sul, Brazil, and in the Department of Rocha, Uruguay, in winter and spring. The fresh green plant was fed to 17 sheep. All sheep developed clinical signs, except 1 that consumed only 4 g/kg bw daily during 10 d. Five of the 9 sheep dosed with 40 g/kg died. Four sheep dosed with plants from Uruguay at 40 g/kg, 6 sheep dosed with 20 g/kg, and 1 sheep dosed with 2 daily doses of 8 g/kg survived. Clinical signs were anorexia, restlessness, ruminal stasis, jaundice and dry feces with mucus or blood. All surviving sheep had photodermatitis in the face, ears, eyes and lips. Histologic lesions were characterized by periportal liver necrosis. Serum levels of AST, GGT and bilirubin were increased. M laetum from Uruguay was less toxic, suggesting a variation in toxicity among plants from different regions.     

Laparoscopic hernia repair of an incisional hernia secondary to placement of an implantable cardioverter defibrillator

We present the laparoscopic repair of a large incisional hernia secondary to placement of a subcostal ICD pulse generator. Laparoscopic repair of large incisional hernias provides a unique and technically feasible form of repair in the 2%-13% of patients who will develop an incisional hernia following an abdominal surgery. This form of hernia repair is associated with minimal morbidity and prompt resumption of patient activities and work.     

Laparoscopic hernia repair in Leicester General Hospital: a prospective audit of 94 patients

Conventional hernia repair is effective in terms of cure but is associated with considerable postoperative pain and delay in return to normal activity. Laparoscopic repair has the potential to reduce pain and speed return to normal activity, but there have been few published reports of the outcome of this operation in the UK. We present a prospective audit of 94 patients who underwent laparoscopic repair. Of the 94 patients, 87 (92.6%) were male and 7 (7.4%) were female. Thirteen of the repairs were bilateral and 12 were recurrent. Two had to be converted to open repair. The mean operating time for unilateral repair was 56 min and for bilateral repair 98 min. Sixty-three patients (67%) were discharged within 24 h and 21 (22.4%) were discharged within 48 h. There were minor complications in 20 patients (21%), eight of whom (8.5%) developed a haematoma. The other minor complications included seromas (2), bruising at the site of the entry port (2), hyperaesthesia in the groin (2), port hernia (1), shoulder tip pain after surgery (3) and postoperative urinary retention (2). Nine (9.5%) patients claimed to have had no pain or discomfort at all; 35 (37.2%) were pain and discomfort free in 2 weeks. Thirty-two (34%) patients returned to normal activities in 2 weeks. With a median follow-up of 8 months 3 (3.2%) recurrences were noted. It is emphasised that this series represents a learning curve and that the operation is developmental. We are now restricting laparoscopic repair to recurrent and bilateral hernias where the technique offers particular advantages.     

Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach

Calcific deposits located within the tendons of the rotator cuff are frequently seen in patients presenting with shoulder pain. The pathogenesis of calcific tendinitis and the optimum management of patients presenting with acute symptoms are unclear. This paper reviews the incidence, proposed etiologies, and a unique treatment approach of rotator cuff calcific tendinitis. A case report of a patient with acute calcific tendinitis and subsequent shoulder motion and strength deficits is presented. A rational evaluation and treatment plan is outlined, which includes management and posttreatment changes, and radiographic findings are discussed. A team-management approach by physical therapy and orthopaedics services is emphasized.     

Inguinal hernia repair. The Nyhus posterior preperitoneal operation

The movement of leukocytes into tissues is regulated by the local production of chemical mediators collectively referred to as chemoattractants. Although chemoattractants constitute a diverse array of molecules, including proteins, peptides, and lipids, they all appear to signal leukocytes through a related family of seven transmembrane-spanning G protein-coupled receptors. The eosinophil is a potent proinflammatory cell that is attracted into tissues during allergic inflammation, parasitic infection, and certain malignancies. Since the molecular mechanisms controlling eosinophil recruitment are incompletely understood, we performed a degenerate polymerase chain reaction on cDNA isolated from murine eosinophils to identify novel chemoattractant receptors. We report the isolation of a cDNA that encodes a 351-amino acid glycoprotein that is 78% identical to a human gene that has been reported to be a purinoceptor (P2Y7) and a leukotriene B4 (LTB4) receptor (BLTR). Chinese hamster ovary (CHO) cells transfected with this cDNA specifically bound [3H]LTB4 with a dissociation constant of 0.6 +/- 0.1 nM. Furthermore, LTB4 induced a dose-dependent intracellular calcium flux in transfected CHO cells. In contrast, [35S]dATP did not specifically bind to these transfectants. This mRNA was expressed at high levels in interleukin 5-exposed eosinophils, elicited peritoneal macrophages and neutrophils, and to a lesser extent interferon gamma stimulated macrophages. Low levels of expression were detected in the lung, lymph node, and spleen of unchallenged mice. Western blot analysis detected the mBLTR protein in murine eosinophils and alveolar macrophages as well as human eosinophils. In addition, elevated levels of mBLTR mRNA were found in the lungs of mice in a murine model of allergic pulmonary inflammation in a time course consistent with the influx of eosinophils. Our findings indicate that this murine receptor is an LTB4 receptor that is highly expressed on activated leukocytes, including eosinophils, and may play an important role in mediating eosinophil recruitment into inflammatory foci.     

Laparoscopic incisional hernia repair after transverse rectus abdominis myocutaneous flap reconstruction

Abdominal wall herniation is a relatively rare but well recognized complication that is known to occur following TRAM flap mobilization. Herein is presented a novel means to approach such a hernia, using the minimally invasive surgical approach to repair the defect with a piece of prosthetic material.     

Laparoscopic inguinal herniorrhaphy: the new gold standard of hernia repair?

The surgical treatment of the common inguinal hernia has been one of the most analyzed and debated topics in medicine. Recently, with the success of laparoscopic cholecystectomy, interest in minimally invasive surgical techniques has led to it's application for inguinal hernia repair. Current laparoscopic herniorrhaphies are based on the principles of conventional open preperitoneal repairs and are classified into two types: 1) transabdominal preperitoneal repair (TAPP) and 2) totally extraperitoneal repair (TEP). Common advantages to both techniques include a decrease in postoperative pain, earlier return to normal activity, and improved cosmesis. Both laparoscopic techniques have the disadvantage of requiring general or regional anesthesia and increased procedural costs. Lastly, there is a concern that laparoscopic hernia repair has not been around long enough to know the risk of late recurrences. Laparoscopic herniorrhaphy, however, is a viable alternative to standard open inguinal hernia repair.     

Laparoscopic Lin operation for the treatment of polycystic liver disease

Non parasitic hepatic cysts are a clinical entity that is often associated with polycystic kidney disease. We report the case of a 75 year-old woman who presented with symptomatic but non complicated polycystic liver disease. The treatment consisted of laparoscopic fenestration of a large simple cyst located in the left hepatic lobe. The postoperative course was uneventful and the patient remains free of symptoms at 18-months follow-up. Selected patients with symptomatic but uncomplicated polycystic liver disease and favourable anatomy benefit from laparoscopic fenestration of the cysts with low morbidity and hospital stay.