ABSTRACT
In the differential diagnosis of biliary obstruction with unknown etiology, biliary fascioliasis should be considered in endemic and nonendemic regions. After diagnostic evaluation, endoscopic retrograde cholangiopancreatography (ERCP) was performed for etiological evaluation and/or treatment of biliary obstruction in five patients with a mean age of 55.8 years. Endoscopic sphincterotomy and cholangiogram revealed linear filling defects in the biliary system. Fasciola hepatica parasites were extracted using balloon and basket catheters in two and three patients, respectively. No morbidity or mortality was observed. F. hepatica infection should be considered as a differential diagnosis of biliary obstruction with unknown etiology in endemic and non-endemic regions. ERCP can be the standard diagnostic and/or therapeutic procedure in cases of biliary obstruction due to fascioliasis. Due to slippery and gel-like characteristics of the parasite, use of a basket catheter in semi-opened position may be required in case of unsuccessful extraction using a balloon catheter.
Subject(s)
Cholangitis/diagnosis , Fasciola hepatica/isolation & purification , Fascioliasis/diagnosis , Pancreatitis/diagnosis , Acute Disease , Adult , Animals , Cholangiopancreatography, Endoscopic Retrograde , Cholangitis/complications , Cholangitis/diagnostic imaging , Diagnosis, Differential , Fascioliasis/complications , Fascioliasis/diagnostic imaging , Female , Humans , Male , Middle Aged , Pancreatitis/complications , Pancreatitis/diagnostic imagingABSTRACT
BACKGROUND AND OBJECTIVES: Laparoscopic reconstruction of ventral hernia is a popular technic today. Patients with large defects have various difficulties of laparoscopic approach. In this study, we aimed to present a new reconstruction technic that combines laparoscopic and open approach in giant incisional hernias. MATERIALS AND METHODS: Between January 2006 and August 2012, 28 patients who were operated consequently for incisional hernia with defect size over 10 cm were included in this study and separated into two groups. Group 1 (n = 12) identifies patients operated with standard laparoscopic approach, whereas Group 2 (n = 16) labels laparoscopic technic combined with open approach. Patients were evaluated in terms of age, gender, body mass index (BMI), mean operation time, length of hospital stay, surgical site infection (SSI) and recurrence rate. RESULTS: There were 12 patients in Group 1 and 16 patients in Group 2. Mean length of hospital stay and SSI rates are similar in both groups. Postoperative seroma formation was observed in 6 patients for Group 1 and in only 1 patient for Group 2. Group 1 had 1 patient who suffered from recurrence where as Group 2 had no recurrence. DISCUSSION: Laparoscopic technic combined with open approach may safely be used as an alternative method for reconstruction of giant incisional hernias.
