-
Journal of Laparoendoscopic & Advanced... Aug 2020Many techniques have been described for the treatment of pediatric inguinal hernia (PIH). Some authors emphasized the importance of disconnecting the sac, to create a... (Comparative Study)
Comparative Study Randomized Controlled Trial
Many techniques have been described for the treatment of pediatric inguinal hernia (PIH). Some authors emphasized the importance of disconnecting the sac, to create a scar, and to close the peritoneum mimicking the open approach. Others stated that peritoneal disconnection alone is enough for treatment of PIH regardless of the size of the internal ring. In this study, we compare the short-term results of laparoscopic disconnection of PIH sac versus disconnection and peritoneal closure. The study was carried from March 2016 to March 2017, on 34 patients with 40 PIH. Patients were randomly divided into two groups: group A, subjected to laparoscopic hernia sac disconnection and group B, subjected to laparoscopic hernia sac disconnection with peritoneal closure. Both groups were compared regarding the operative details, including complications and conversion, postoperative complications and recurrence. Group A included 20 hernias in 15 patients, whereas group B included 20 hernias in 19 patients. The age ranged from 1 to 23 months. In group A, the mean operative time (OT) was 34.6 and 39.4 minutes, for unilateral and bilateral cases, respectively, whereas in group B, it was 45.1 minutes for unilateral cases and 65 minutes for 1 bilateral case. The OT was significantly shorter in group A for unilateral cases. There was no conversion and no intraoperative complications. Three recurrences occurred in group A (15% of hernias/20% of cases) with no recurrences in group B; difference was statistically insignificant. All 3 recurrences occurred in hernias with an internal ring diameter (IRD) >10 mm. Hospital stay was statistically shorter in group B. Both laparoscopic sac disconnection with internal ring closure and sac disconnection only are safe and effective treatments of PIH. However, the latter technique is not recommended for cases with IRD >10 mm because of the unacceptable high recurrence with rings >10 mm.
Topics: Child, Preschool; Female; Follow-Up Studies; Hernia, Inguinal; Herniorrhaphy; Humans; Infant; Laparoscopy; Length of Stay; Male; Operative Time; Peritoneum; Postoperative Complications; Prospective Studies; Recurrence; Treatment Outcome
PubMed: 32598217
DOI: 10.1089/lap.2018.0679 -
AJR. American Journal of Roentgenology Oct 2020This article reviews the embryologic development, relevant anatomy, and imaging features, on CT, of pathologic processes involving the lesser sac and foramen of... (Review)
Review
This article reviews the embryologic development, relevant anatomy, and imaging features, on CT, of pathologic processes involving the lesser sac and foramen of Winslow. The lesser peritoneal sac is an intricate anatomic region involved in many disease processes. It is a significant conduit for the spread of disease within the peritoneal cavity. The spectrum of pathologic processes pertaining to the lesser sac can be classified on the basis of the type of involvement, such as a fluid collection (e.g., transudate, exudate, bile, and blood), a mass (e.g., neoplastic or nonneoplastic conditions and lymphadenopathy), or an internal hernia into the lesser sac.
Topics: Humans; Peritoneal Cavity; Peritoneal Diseases; Tomography, X-Ray Computed
PubMed: 32783559
DOI: 10.2214/AJR.19.22749 -
Diseases of the Colon and Rectum Dec 2022
Topics: Humans; Female; Douglas' Pouch; Endometriosis
PubMed: 36102875
DOI: 10.1097/DCR.0000000000002604 -
Advances in Clinical and Experimental... Jul 2021We don’t understand Alzheimer, its origin and disease mechanisms. The absence of disease-modifying treatments for Alzheimer today is due to the amyloid...
We don’t understand Alzheimer, its origin and disease mechanisms. The absence of disease-modifying treatments for Alzheimer today is due to the amyloid hypothesis, a misguided hypothesis of Alzheimer’s disease etiology, which has dominated Alzheimer research, drug development, and clinical trials for 30 years. However, the hypothesis is not dead yet, as exemplified by the recent resurrection of clinical trials with aducanumab. Recent advances in Alzheimer research include astrocytes, synaptic function and glutamate signaling. Many studies indicate EAAT2 as a promising target in drug discovery and clinical development for novel therapies in Alzheimer’s disease, and other neurologic and psychiatric diseases.
Topics: Alzheimer Disease; Douglas' Pouch; Humans
PubMed: 34313409
DOI: 10.17219/acem/139501 -
Asian Journal of Surgery Feb 2024
Topics: Humans; Hernia, Inguinal; Herniorrhaphy; Peritoneum; Laparoscopy; Peritoneal Neoplasms; Mesothelioma; Retrospective Studies; Treatment Outcome
PubMed: 37914647
DOI: 10.1016/j.asjsur.2023.10.082 -
Magyar Sebeszet Nov 2021Introduction: Not only atraumatic surgical technique, precise bleeding control, removal foreign materials from the abdomen, but also avoiding desiccation or mechanical... (Review)
Review
Introduction: Not only atraumatic surgical technique, precise bleeding control, removal foreign materials from the abdomen, but also avoiding desiccation or mechanical damage of peritoneal surface at abdominal surgery mean today evidence based expectation. Peritoneum with its extensive surface and special histological structure represents an important factor in normal physiological processes, furthermore as “Guard of abdomen” it has an important role to localise inflammatory reactions, useful as dialysing surface and provides also possibility for hyperthermic abdominal chemotherapy in tumour treatment. Largest part of peritoneal sac covers small intestine and colon. To prevent postoperative complications it is necessary to avoid desiccation of intestinal tract at laparoscopic and at open procedures as well – consequently “rehyration” is a routine recommendation today. Desiccation of intestinal tract results postoperative adhesions, furthermore damage of serosa will increase permeability of intestine wall and can result perforation. All the surgical recommendations suggest keeping intestine moist, whereas there are only a few real studies in surgical literature to support or to deny this theory. Our study reviews the pathophysiological and surgical respects of this situation and summarizes the results of latest researches of combined functions of peritoneum.
Topics: Humans; Laparoscopy; Peritoneum; Postoperative Complications
PubMed: 34821584
DOI: 10.1556/1046.74.2021.4.7 -
California Medicine Apr 1952Cul-de-sac puncture for introduction of a culdoscope is easily made with the patient in the knee-chest position. With the use of the instrument, the pelvic organs can be...
Cul-de-sac puncture for introduction of a culdoscope is easily made with the patient in the knee-chest position. With the use of the instrument, the pelvic organs can be viewed clearly. Culdoscopic examination of 45 patients was carried out. In all cases in which laparotomy was done after the examination, the culdoscopic observations and diagnosis were confirmed. In no case in which tubal pregnancy was present, was the diagnosis missed in culdoscopic examination. Patients were only slightly uncomfortable after the examination. There was no evidence of pelvic peritonitis in any patient, and no pregnant patient aborted as a result of the procedure.
Topics: Culdoscopes; Culdoscopy; Douglas' Pouch; Female; Genital Diseases, Female; Humans; Laparotomy; Pelvis; Pregnancy
PubMed: 14925833
DOI: No ID Found -
The Journal of Trauma and Acute Care... Dec 2021
Topics: Abdomen; Accidents, Traffic; Ascitic Fluid; Diagnosis, Differential; Female; Humans; Incidental Findings; Lymphangioma, Cystic; Pancreatectomy; Pancreatic Cyst; Pancreatic Neoplasms; Peritoneal Cavity; Splenectomy; Treatment Outcome; Ultrasonography; Wounds, Nonpenetrating; Young Adult
PubMed: 31261242
DOI: 10.1097/TA.0000000000002421 -
Hernia : the Journal of Hernias and... Apr 2021Repair of transverse incisional hernias is a surgical challenge with current methods of abdominal wall reconstruction. The peritoneal flap hernioplasty addresses this...
BACKGROUND
Repair of transverse incisional hernias is a surgical challenge with current methods of abdominal wall reconstruction. The peritoneal flap hernioplasty addresses this problem using flaps of hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space exploiting the retro-rectus space medially and the avascular plane between the internal and external oblique muscles laterally. The operative technique and long-term results of 80 consecutive cases with transverse incisional hernias undergoing repair with this method are reported.
METHODS
Patients undergoing elective peritoneal flap hernioplasty repair for transverse incisional hernias from Jan. 1, 2010 to Dec. 31, 2014 were identified from the Lothian Surgical Audit system, a prospectively-maintained computer database of all surgical procedures in the Edinburgh region of south-east Scotland. Patient demographics and clinical data were obtained from the hospital case-notes. Follow-up data were obtained in May 2019 from hospital records and telephone interview.
RESULTS
80 patients, (n = 53 male, 66%) were identified. Mean follow-up was 83 months (range 55-114 months) and mean postoperative stay was 6.4 days (range 1-23 days). Eleven repairs (14%) were for recurrent hernia. Mean mesh size applied (Optilene Elastic, 48 g/m, BBraun) was 747 cm (ranged 150-1500 cm). Redundant skin excision was performed in 54% of cases. Altogether, seven patients (8.8%) presented with postoperative complications: five superficial wound infections (6.3%), one symptomatic seroma (1.3%) and one recurrence (1.3%) within the follow-up period.
CONCLUSION
The peritoneal flap hernioplasty is associated with few complications and a very low recurrence rate. We propose this technique as the method of choice for reconstruction of transverse abdominal incisional hernias when primary fascial apposition is not possible.
Topics: Hernia, Ventral; Herniorrhaphy; Humans; Incisional Hernia; Male; Peritoneum; Postoperative Complications; Recurrence; Surgical Mesh
PubMed: 31813114
DOI: 10.1007/s10029-019-02099-0 -
Peritoneal Dialysis International :... 2010Pathological conditions involving the lesser sac of the peritoneal cavity in patients on peritoneal dialysis (PD) can pose significant diagnostic and therapeutic...
Pathological conditions involving the lesser sac of the peritoneal cavity in patients on peritoneal dialysis (PD) can pose significant diagnostic and therapeutic challenges. Lack of appreciation of these challenges may delay diagnosis and compromise outcome. A case series by Li and colleagues in this issue of Peritoneal Dialysis International highlights the diagnostic challenges presented by lesser sac infection in PD patients, and in this accompanying commentary we discuss the development and anatomy of the lesser sac, as well as the pathological conditions and investigations relevant to the management of patients on PD.
Topics: Abdominal Abscess; Abdominal Pain; Female; Humans; Male; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis
PubMed: 20829547
DOI: 10.3747/pdi.2010.00060