Triple mesh technique in repair of recurrent lumbar incisional hernia

Lumbar hernias occur infrequently and can be congenital, primary (inferior or Petit type, and superior or Grynfeltt type), post-traumatic, or incisional. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions for which various surgical method in context of meshplasty are available. In this case 60 yr. male hypertensive patient presented to the outpatient clinic of institute with recurrent left side lumbar incisional hernia, patient was previously operated for left side nephrolithiasis 15 years back and onlay meshplasty 2 years back for incisional hernia. The patient was operated under high risk for recurrent incisional hernia repair by triple layered meshplasties in the same sitting. Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice with adjuvant clinical findings, which allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures for which our surgical approach included a triple mesh repair consisting of underlay, inlay and onlay meshplasty thereby anticipating further such incidences of incisional hernia.

What can we do for the recurrent-tumor patients who underwent hepatectomy for hepatocellular carcinoma / 中国实用外科杂志

Some of the patients with hepatocellular carcinoma could be performed hepatectomy and get optimal postoperative outcomes with tumor-free long-term survival which encourage surgeon to carry on the surgery with tremendous enthusiam.Unfortunately the others are not the case even though surgeons have done their best routinely and standardly and the tumor recurs in the liver in short time after surgery. For the sake of the patient treatment,the confidence should not be lost,there are a lot of things to be done which include re-resection, radio freuquency ablation,transcatheter arterial chemoembolization,liver transplantation respectively and individualizedly in order to receive better prognosis and longer-term survival.

Prevention of Post-operative Recurrence in Crohn's Disease

At one year after a first resection in patients with Crohn's disease, up to 80% of patients show endoscopically-determined recurrence of disease, 10-20% have a clinical relapse and 5% have to undergo surgery again. However, there are currently no guidelines for the postoperative maintenance therapy for patients with Crohn's disease, and considerable uncertainty remains as to the efficacy of the various postoperative treatments. New lesions can be visualized endoscopically within weeks to months after performing ileal resection and creating an ileocolonic anastomosis in the neoterminal ileum. The evolution of these lesions mimics the natural history of ileal Crohn's disease at the onset. If we are able to prevent the recurrence of early lesions, then we will probably interrupt the natural course of this disease. Since there is a lag time of months to years between the development of recurrent lesions in the bowel and the recurrence of symptoms, we recommend performing endoscopy of the bowel 6 months after the initial operation to assess the severity of recurrence, and the strategy for further treatment should be based on this assessment. The development of explicit criteria for the appropriateness of various postoperative treatment regimens is needed to aid physicians when they making the clinical decisions in this context.

A Case of Recurrence of Spinal Tuberculosis Treatment with Posterior Approach and Followed by Successful Anterior Fusion on the Lumbosacral Spine

In the treatment of spine tuberculosis, anterior spinal fusion has been a widely accepted procedure since Hodgson and Stock in 1956 bacause of its many advantages. Posterior approch is a simplier & safer procedure. However the destructed vertebral body can not be removes completely by this procedure. A 50 years old female patient was admitted with lumbosacral tuberculosis showing massive destruction of the L5 & S1 vertebral body and abscess formation. We initially performed a curettage and debridement by the posterior approach, combined with chemotheraphy. A anterior fusion was a more risky procedure to the patient with poor general condition, severe adhesion and long destruction of the entire L5 & upper S1 vertebral body. Occurred 35 days after first operation. Curettage and debridement were again undertaken by the posterior approach on the second operation. However 45 days late, it recurred again. Therefore, we performed the anterior fusion as the third procedure and had a successful outcome. We believe that in some cases, the advantages of posterior approach and fusion may be a pitfall and should be carefully applied in the treatment of spine tuberculosis.