Laparoscopic repair of ventral hernia

Laparoscopic repair of ventral hernia is rapidly becoming more commonplace in the armamentarium of general surgeons. Its utility and low recurrence rates make it a very attractive option. The technique of the laparoscopic repair is based on the principle described by Stoppa, however the hernial sac is not dissected and is left behind. This minimizes difficult dissection, blood loss and large incisions. The laparoscopic technique also ensures that all defects are seen and repaired. The aim of the study is to evaluate this technique in comparison to open onlay mesh repair of ventral hernia. From November 2004 to October 2006, 60 patients with ventral hernias were equally randomized into two groups; in group I, laparoscopic repair was practiced using a composite mesh [Parietex [registered sign]], fixed intraperitoneally by sutures and tackers, while in group II, open mesh repair was employed after dissection, herniotomy and peritoneal closure, a prolene mesh used to close the defect, fixed by continuous prolene 0 suture. The two groups were compared in regard to operative time, postoperative complications, hospital stay, recurrence and the cost. The patients in the two groups were comparable at baseline in terms of sex, age, presenting complaints, and comorbid conditions. The mean surgery durations were 90.6 minutes for the laparoscopic repair and 99.3 minutes for the open repair with no significant difference. The mean postoperative stay was shorter for laparoscopic group than for open hernia group [1.8 Vs 3.7 days with significant difference]. There were fewer complications [20% and no recurrences] among the patients who underwent laparoscopic repair than among those who had open repair [40% and no recurrence]. The cost of composite mesh and tacker were significantly higher than the cost of prolene mesh. Laparoscopic ventral hernia repair is safe and resulted in shorter hospital stays, fewer complications and so far no recurrence during the period of follow-up

Outcomes of laparoscopic cholecystectomy during the first admission of acute biliary pancreatitis

Biliary stones are the leading cause of acute pancreatitis. Although cholecystectomy and selective endoscopic retrograde cholangiography [ERC] comprise the current treatment in patients with acute biliary pancreatitis [ABP], the time of intervention is still controversial. The aim of the study is to evaluate the policy of laparoscopic cholecystectomy for patients with ABP during the initial admission. The study was carried out in the period November 2004- October 2006. Thirty patients with ABP were subjected to laparoscopic cholecystectomy during the index admission after clinical and biochemical resolution of the attack. The severity of the disease was assessed using Ranson' criteria; 3 or less indicates mild pancreatitis, while more than 3 is considered severe pancreatitis. ERC and endoscopic sphincterotomy [ES] are used on a selective basis pre- and post-operatively. Standard 4- ports technique was used; timing for surgery, operative difficulty, conversion rate, post-operative morbidity and mortality were evaluated. A total of 30 patients with the diagnosis of ABP were included in this study. Twenty-five patients [83.3%] were categorized as having mild pancreatitis [Ranson' criteria 3]. All patients were managed conservatively and underwent laparoscopic cholecystectomy after clinical and biochemical resolution of the attack on the same hospital admission. The time from admission to the operating room ranged from 3-8 days [median 5.1] in mild pancreatitis, while in severe pancreatitis; it ranged from 7-28 days [median 20.2]. ERC and ES were performed on selective basis for 6 patients pre-operatively and in 2 patients post-operatively [26.6%]. Magnetic resonance cholangiopancreatography [MRCP] was also done on selective basis to clear the anatomy of the region of ampulla of Vater in 4 patients [13.3%] for whom ultrasound [US] was not decisive. Laparoscopic cholecystectomy was feasible in spite of edema, inflammation and adhesion. The rates of conversion, morbidity and mortality were 6.6%, 33.3% and 3.3%, respectively. Definitive treatment of ABP can be accomplished effectively and safely by cholecystectomy following clinical and biochemical improvement with acceptable morbidity and mortality during the same admission

Basal cell carcinoma: expression of apoptosis suppressing protein BCL-2

The Bcl-2 protein increases cell longevity by inhibiting apoptosis [programed cell death]. The aim of the study is to evaluate the expression and possible role of Bcl-2 in basal cell carcinoma [BCC]. Twenty two patients with 24 lesions [BCCs] were included in the study. After excision with safety margins, routine paraffin section of formalin-fixed BCCs were labeled with anti-Bcl-2 monoclonal antibodies using a biotin-avidin immunoperoxidase procedure. Apoptotic cells were counted in ten high power fields [HPFs] of each section. The results were compared with those in ten age and sex matched controls. Excision with reconstructive procedures was done with a safety margin [5mm]. Simple undermining and advancement was done in 8 patients, post-auricular full thickness skin graft in 7 patients, local flaps [V-Y advancement flap, rotation flap] in 9 patients. In normal skin samples, Bcl-2 was only expressed by the basal keratinocytes in one of ten [10%] samples. The mean apoptotic index [AI] was 0.5 cells/10 HPFs. In BCC, Bcl-2 was expressed by tumor cells in 21/24 cases [87.5%] with apoptotic index AI ranging between 2-11 cells/10 HPFs with a mean 4.94 +/- 1.2 cells [statistically highly significant]. Bcl-2 over-expression in the majority of BCCs may be the initial factor that predisposes to malignant transformation of keratinocytes by inhibiting apoptosis