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Surgical Laparoscopy, Endoscopy &... Oct 2021There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at...
BACKGROUND
There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes.
PURPOSE
The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children.
PATIENTS AND METHODS
Needlescopic division of the hernial sac was carried out on 369 children in 6 pediatric tertiary centers during the period from August 2016 to May 2019. All hernias were repaired by a novel needlescopic procedure that replicates all the steps of the open herniotomy.
RESULTS
A total of 369 patients with 410 hernias were included in this study. They were 232 (62.9%) males and 137 (37.1%) females, with a mean age of 3.58±1.26 (range=2 to 8 y) and mean internal inguinal ring diameter was 13.65±3.85 mm (range=8 to 20 mm). The mean operative time was 23.36±4.67 minutes for bilateral and 14.28±2.98 minutes for unilateral cases. All cases were completed without conversion to conventional laparoscopy. All cases were followed up for a mean of 19.6±3.2 months. None of our patients developed recurrence or testicular atrophy and the scars were nearly invisible 3 months postoperatively.
CONCLUSIONS
Needlescopic pediatric inguinal hernia repair using disconnection of the hernia sac at internal inguinal ring with purse-string suture closure of peritoneum is feasible and safe with no recurrence and with outstanding cosmetic results.
Topics: Child; Child, Preschool; Female; Hernia, Inguinal; Herniorrhaphy; Humans; Infant; Inguinal Canal; Laparoscopy; Male; Peritoneum; Recurrence; Retrospective Studies; Treatment Outcome
PubMed: 34608108
DOI: 10.1097/SLE.0000000000001001 -
Journal of Evaluation in Clinical... Oct 2021
Topics: Douglas' Pouch; Humans; Laparoscopy; Psychotherapy
PubMed: 32567111
DOI: 10.1111/jep.13434 -
Gynecologic Oncology Oct 2012This 48 yr old lady underwent laparotomy for primary appendiceal carcinoma metastatic within the peritoneal cavity including the lesser omentum (LO) and supragastric...
This 48 yr old lady underwent laparotomy for primary appendiceal carcinoma metastatic within the peritoneal cavity including the lesser omentum (LO) and supragastric lesser sac (Fig. 1). The left triangular ligament was divided allowing retraction of the left lobe of the liver. The stomachwasmanually pulled to stretch out the LO and facilitate resection. The left gastric, common hepatic and left hepatic arteries and the vagal nerves of Latarjet running along the lesser curve of the stomachwere avoided. Tumorwasmobilized frombetween the left liver and anterior caudate lobe and from behind the pont hepatique. Care was taken to avoid damage to a branch of the left hepatic artery running in the roof of the lesser sac. The stomach was elevated and the caudate lobe carefully retracted to expose the posterior surface of the supragastric lesser sac formed by a single layer of peritoneum. This was stripped off and then detached from the caudate lobe. Tumor was then stripped or wiped off the anterior surface of the caudate lobe. Residual visible tumor was ablated. At the end of the procedure there was no visible disease. The patientwas then treatedwith hyperthermic intraperitoneal chemotherapy with mitomycin for 90min. The postoperative course was uncomplicated apart from short-term ileus and urinary retention.
Topics: Appendiceal Neoplasms; Female; Humans; Middle Aged; Peritoneal Cavity; Peritoneal Neoplasms; Peritoneum
PubMed: 22727984
DOI: 10.1016/j.ygyno.2012.05.036 -
Journal of Minimally Invasive Gynecology 2017To assess the potential role of peritoneal and omental biopsies in women undergoing risk-reducing salpingo-oopherectomy (RRSO) for prophylactic management of hereditary... (Observational Study)
Observational Study
STUDY OBJECTIVE
To assess the potential role of peritoneal and omental biopsies in women undergoing risk-reducing salpingo-oopherectomy (RRSO) for prophylactic management of hereditary breast/ovarian cancer (HBOC) syndromes.
DESIGN
A retrospective observational cohort (Canadian Task Force classification II.1).
SETTING
An academic gynecology practice.
PATIENTS
All women who underwent RRSO for a high-risk BRCA1/2 mutation or deletion at a single institution between January 2003 and June 2016.
INTERVENTIONS
After obtaining institutional review board approval, patient demographics, types of surgical intervention, histopathology reports, and outcomes were abstracted. Bilateral fallopian tubes were histologically evaluated using the "sectioning and extensively examining of the fimbriated end" protocol. Descriptive statistics were used to summarize findings.
MEASUREMENTS AND MAIN RESULTS
Seventy women underwent RRSO within the study window; 60% (n = 42) carried a high-risk mutation in BRCA1, 37.1% (n = 26) carried a high-risk mutation in BRCA2, and 2.9% (n = 2) had a high-risk BRCA deletion identified by BRAC analysis rearrangement testing (BART). Serous tubal intraepithelial carcinomas were identified in the distal fallopian tube of 3 subjects. In addition to RRSO, subjects underwent pelvic washings (n = 58, 82.9%), omental biopsy (n = 44, 62.9%), peritoneal biopsies of the bilateral paracolic gutters (n = 51, 72.9%), anterior and posterior cul-de-sac (n = 53, 75.7%), and rectosigmoid mesentery (n = 11, 15.7%). Rare atypical cells favoring reactive cells were identified in pelvic washings of 1 subject (1.7%) with histologically normal fallopian tubes. No evidence of atypical mesothelial proliferations or carcinoma was identified in any omental or peritoneal biopsies. The mean duration of follow-up was 32.5 ± 24.7 months. At the last contact, 3 women (4.3%) had died of metastatic breast cancer, whereas another 3 (4.3%) had been diagnosed with a recurrence of their breast cancer. All other subjects were alive and well (n = 64, 91.4%).
CONCLUSION
The routine use of peritoneal and omental biopsies for women undergoing RRSO does not appear to improve detection of occult malignancy.
Topics: Adult; Aged; BRCA1 Protein; BRCA2 Protein; Biopsy; Breast Neoplasms; Cystadenocarcinoma, Serous; Diagnostic Tests, Routine; Fallopian Tube Neoplasms; Fallopian Tubes; Female; Genes, BRCA1; Genes, BRCA2; Humans; Middle Aged; Mutation; Neoplasm Metastasis; Neoplasm Recurrence, Local; Omentum; Ovarian Neoplasms; Peritoneum; Retrospective Studies; Risk Factors; Salpingo-oophorectomy
PubMed: 28285055
DOI: 10.1016/j.jmig.2017.03.001 -
Human Reproduction (Oxford, England) Mar 2005Omental pregnancy is a very rare form of ectopic pregnancy. Here we presented a case of primary omental pregnancy diagnosed at surgical exploration. A 28 year old woman... (Review)
Review
Omental pregnancy is a very rare form of ectopic pregnancy. Here we presented a case of primary omental pregnancy diagnosed at surgical exploration. A 28 year old woman submitted with severe abdominal pain, without any delay of menstruation. History of the patient revealed no use of contraceptive method. There was no gestational sac in the endometrial cavity and no tubal ring in the adnexa, but free peritoneal fluid in the pouch of Douglas was detected at ultrasonography. Laparotomy was done according to pre-operative diagnosis of ruptured tubal pregnancy. Bilateral tubes and ovaries were intact; omental pregnancy was detected and partial omentectomy was performed. Although 16 cases of omental pregnancy (mostly secondary) were reported in the literature, herein we describe a primary omental pregnancy without adnexial involvement.
Topics: Abdominal Pain; Adult; Ascitic Fluid; Diagnostic Techniques, Surgical; Douglas' Pouch; Female; Humans; Menstrual Cycle; Omentum; Pregnancy; Pregnancy, Ectopic; Ultrasonography
PubMed: 15640259
DOI: 10.1093/humrep/deh683 -
Journal of Minimally Invasive Gynecology 2020
Topics: Douglas' Pouch; Endometriosis; Female; Humans; Hysterectomy; Laparoscopy
PubMed: 31843694
DOI: 10.1016/j.jmig.2019.10.026 -
AJR. American Journal of Roentgenology May 1988Seventy-three abdominopelvic contrast-enhanced CT scans obtained in 60 patients with peritoneal tumor spread were reviewed retrospectively to determine the CT signs of...
Seventy-three abdominopelvic contrast-enhanced CT scans obtained in 60 patients with peritoneal tumor spread were reviewed retrospectively to determine the CT signs of peritoneal malignancy. Ascites was present in 54 studies (74%) and was the most common CT finding. Loculation of the fluid occurred in 25 (46%) of these. In nine (17%) of the 54, a new finding, absence of cul-de-sac fluid in the presence of generalized ascites, was noted. Parietal peritoneal thickening with contrast enhancement of the peritoneum, making the peritoneum visible as a thin line along the abdominal wall, was present in 45 (62%) of studies. This is believed to represent confluent peritoneal metastases. Small-bowel involvement was present in half of the cases (wall thickening and irregularity with or without obstruction). Tumor involvement of the omentum was visible as soft-tissue permeation of fat, enhancing nodules, and/or an omental cake. Of the 26 patients without a previously known malignancy, identification of the primary tumor in addition to peritoneal carcinomatosis was possible in 13 (50%). Appreciation of the spectrum of CT findings in peritoneal carcinomatosis is essential for accurate evaluation of scans in patients with abdominopelvic malignancies.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ascites; Female; Humans; Male; Middle Aged; Omentum; Peritoneal Neoplasms; Peritoneum; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 3258703
DOI: 10.2214/ajr.150.5.1035 -
Archives of Gynecology and Obstetrics Feb 2009Extraovarian yolk sac tumors (YSTs) arising in the omentum represent an exceedingly rare malignancy. (Review)
Review
BACKGROUND
Extraovarian yolk sac tumors (YSTs) arising in the omentum represent an exceedingly rare malignancy.
CASE
A 37-year-old Korean woman was admitted with a history of lower abdominal pain of 3 weeks duration. Pelvic computerized tomography (CT) scanning reported a bilateral ovarian malignancy with peritoneal seeding. Exploration findings revealed a greater omental mass and the result of frozen biopsy was adenocarcinoma or mesothelioma. She was treated with supracolic omentectomy, bilateral salpingo-oophorectomy, pelvic and paraaortic lymph node dissection, multiple peritoneal biopsies and appendectomy. Histological evaluation of the specimen after operation exhibited typical patterns of YST and stained for alpha-fetoprotein (AFP) and cytokeratin. Four courses of bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy repeated every 3 weeks were added to therapy and she has remained free of disease for 1 year after completion of the therapy.
CONCLUSION
To our knowledge this is the fourth case of primary omental YST. A review of the literature indicates that the diagnosis of YST requires proper evaluations of tumor makers and a skilled pathologist for analysis of frozen sections.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Appendectomy; Bleomycin; Cisplatin; Endodermal Sinus Tumor; Etoposide; Fallopian Tubes; Female; Histocytochemistry; Humans; Keratins; Lymph Node Excision; Omentum; Ovariectomy; Peritoneal Neoplasms; Peritoneum; Tomography, X-Ray Computed; alpha-Fetoproteins
PubMed: 18648830
DOI: 10.1007/s00404-008-0661-0 -
Journal of Immunology (Baltimore, Md. :... Dec 2021Tissue-resident macrophages (TRMΦ) are important immune sentinels responsible for maintaining tissue and immune homeostasis within their specific niche. Recently, the...
Tissue-resident macrophages (TRMΦ) are important immune sentinels responsible for maintaining tissue and immune homeostasis within their specific niche. Recently, the origins of TRMΦ have undergone intense scrutiny, in which now most TRMΦ are thought to originate early during embryonic development independent of hematopoietic stem cells (HSCs). We previously characterized two distinct subsets of mouse peritoneal cavity macrophages (MΦ) (large and small peritoneal MΦ) whose origins and relationship to both fetal and adult long-term (LT) HSCs have not been fully investigated. In this study, we employ highly purified LT-HSC transplantation and in vivo lineage tracing to show a dual ontogeny for large and small peritoneal MΦ, in which the initial wave of peritoneal MΦ is seeded from yolk sac-derived precursors, which later require LT-HSCs for regeneration. In contrast, transplanted fetal and adult LT-HSCs are not able to regenerate brain-resident microglia. Thus, we demonstrate that LT-HSCs retain the potential to develop into TRMΦ, but their requirement is tissue specific in the peritoneum and brain.
Topics: Animals; Brain; Cell Lineage; Embryonic Development; Female; Hematopoietic Stem Cells; Macrophages; Mice; Organ Specificity; Peritoneum; Pregnancy; Regeneration
PubMed: 34810224
DOI: 10.4049/jimmunol.2100344 -
Surgical Endoscopy Jan 2021Ventral hernia repair is typically performed via a transabdominal approach and the peritoneal cavity is opened and explored. Totally extraperitoneal ventral hernia...
BACKGROUND
Ventral hernia repair is typically performed via a transabdominal approach and the peritoneal cavity is opened and explored. Totally extraperitoneal ventral hernia repair (TEVHR) facilitates dissection of the hernia sac without entering the peritoneal cavity. This study evaluates our experience of TEVHR, addressing technique, decision-making, and outcomes.
METHODS
This is an IRB-approved retrospective review of open TEVHR performed between January 2012 and December 2016. Medical records were reviewed for patient demographics, operative details, postoperative outcomes, hospital readmissions, and reoperations.
RESULTS
One hundred sixty-six patients underwent TEVHR (84 males, 82 females) with a mean BMI range of 30-39. Eighty-six percent of patients underwent repair for primary or first-time recurrent hernia, and 89% CDC wound class I. Median hernia defect size was 135 cm. Hernia repair techniques included Rives-Stoppa (34%) or transversus abdominis release (57%). Median operative time was 175 min, median blood loss 100 mL, and median length of stay 4 days. There were no unplanned bowel resections or enterotomies. Four cases required intraperitoneal entry to explant prior mesh. Wound complication rate was 27%: 9% seroma drainage, 18% superficial surgical site infection (SSI), and 2% deep space SSI. Five patients (3%) required reoperation for wound or mesh complications. Over the study, four patients were hospitalized for postoperative small bowel obstruction and managed non-operatively. Of the 166 patients, 96%, 54%, and 44% were seen at 3-month, 6-month, and 12-month follow-ups, respectively. Recurrences were observed in 2% of patients at 12-month follow-up. One patient developed an enterocutaneous fistula 28 months postoperatively.
CONCLUSIONS
TEVHR is a safe alternative to traditional transabdominal approaches to ventral hernia repair. The extraperitoneal dissection facilitates hernia repair, avoiding peritoneal entry and adhesiolysis, resulting in decreased operative times. In our study, there was low risk for postoperative bowel obstruction and enterotomy. Future prospective studies with long-term follow-up are required to draw definitive conclusions.
Topics: Abdominal Wall; Abdominoplasty; Aged; Female; Hernia, Ventral; Herniorrhaphy; Humans; Male; Middle Aged; Operative Time; Peritoneum; Postoperative Complications; Recurrence; Reoperation; Retrospective Studies; Seroma; Surgical Wound Infection
PubMed: 32030549
DOI: 10.1007/s00464-020-07374-1