ABSTRACT
Purpose@#Single-incision cholecystectomy is a surgical method that offers comparable results to conventional laparoscopic cholecystectomy. However, a high risk of postoperative incisional hernia is an issue in single-incision cholecystectomy. This study evaluated the risk factors and incidences of incisional hernia after single-incision cholecystectomy and the advantage issue of using barbed suture material during wound closures. @*Methods@#A total of 1,111 patients underwent laparoscopic or robotic single-incision cholecystectomy between March 2014 and February 2020 at our institution at CHA Bundang Medical Center. During this period, there were 693 patients who underwent wound closure with monofilament suture material (Monosyn 2-0; B. Braun) and the other 418 patients used barbed suture material (Stratafix 2-0; Ethicon). @*Results@#The two patient groups were comparable in age, body mass index, and diagnosis. The total incidence of incisional hernia after single-incision cholecystectomy was 0.5% (five cases). All patients who developed incisional hernia were in the monofilament suture material group (0.7% vs. 0%, p = 0.021). The inf luence of predictive and possible risk factors on incisional hernia rate was analyzed. Among these factors, only old age was an independent predictive risk factor of incisional hernia. @*Conclusion@#Our study showed a low incidence of incisional hernia, all of which occurred in the monofilament suture material group. If technically appropriate, single-incision cholecystectomy does not appear to present a high incidence of hernia. Barbed suture material can be safely applied in wound closure showing comparable incisional hernia incidence to monofilament suture material.
ABSTRACT
Purpose@#Single-incision cholecystectomy is a surgical method that offers comparable results to conventional laparoscopic cholecystectomy. However, a high risk of postoperative incisional hernia is an issue in single-incision cholecystectomy. This study evaluated the risk factors and incidences of incisional hernia after single-incision cholecystectomy and the advantage issue of using barbed suture material during wound closures. @*Methods@#A total of 1,111 patients underwent laparoscopic or robotic single-incision cholecystectomy between March 2014 and February 2020 at our institution at CHA Bundang Medical Center. During this period, there were 693 patients who underwent wound closure with monofilament suture material (Monosyn 2-0; B. Braun) and the other 418 patients used barbed suture material (Stratafix 2-0; Ethicon). @*Results@#The two patient groups were comparable in age, body mass index, and diagnosis. The total incidence of incisional hernia after single-incision cholecystectomy was 0.5% (five cases). All patients who developed incisional hernia were in the monofilament suture material group (0.7% vs. 0%, p = 0.021). The inf luence of predictive and possible risk factors on incisional hernia rate was analyzed. Among these factors, only old age was an independent predictive risk factor of incisional hernia. @*Conclusion@#Our study showed a low incidence of incisional hernia, all of which occurred in the monofilament suture material group. If technically appropriate, single-incision cholecystectomy does not appear to present a high incidence of hernia. Barbed suture material can be safely applied in wound closure showing comparable incisional hernia incidence to monofilament suture material.
ABSTRACT
Metastasis to the pituitary gland from systemic cancer is a rare condition. The breast and lung are the most common sites of primary tumor metastasis. Most often, they occur in the setting of widespread metastatic disease, which most frequently occurs in elderly patients. However, an increase in the incidence of solitary pituitary metastasis of breast cancer as the first recurrence has been reported. Diabetes insipidus is the most frequent symptom at presentation, and visual field defects or cranial nerve deficits are common symptoms of pituitary metastasis. Unlikely these symptoms, deficiencies of anterior pituitary hormones may only become evident in critical situation because symptoms are of an insidious onset and sometimes nonspecific. We report here on a rare case of solitary pituitary metastasis from breast cancer presenting as hyponatremia without other symptoms.
Subject(s)
Aged , Humans , Breast Neoplasms , Breast , Cranial Nerves , Diabetes Insipidus , Epidermal Growth Factor , Hyponatremia , Incidence , Lung , Neoplasm Metastasis , Pituitary Gland , Pituitary Hormones, Anterior , ErbB Receptors , Recurrence , Visual FieldsABSTRACT
A. xylosoxidans infection can result in potentially severe sequelae, especially in unhealthy populations. We present a rare case of infectious skin ulceration with scar contracture due to A. xylosoxidans in a healthy patient. A 53-year-old male patient without underlying disease and trauma history visited our department for an irritating skin ulcer with purulent discharge on the right lower leg. The chronic wound on the leg exists since he got contact burn 30 years ago. The wound did not respond to treatment, and the wound culture results indicated A. xylosoxidans. Given the incurable character of A. xylosoxidans, we performed a wide excision and split thickness skin graft with collagen-elastin matrix (Matriderm(R)). A. xylosoxidans is an opportunistic, aerobic, gram-negative, rod-shaped bacterium that is oxidase positive. According to reports, A. xylosoxidans is not sensitive to many antibiotics and can cause bacteremia. It is suggested that the blood supply is compromised near a scar lesion despite the fact that blood flow is rather increased during the initial scar formation phase. Therefore, we presumed that the infection was most likely caused by low blood circulation due to scar contracture. Thus, when a scar contracture is present, A. xylosoxidans infection can manifest in a healthy patient.