ABSTRACT
Pseudomyxoma peritonei (PMP) is an uncommon "borderline malignancy" generally arising from a perforated appendiceal epithelial tumour. Optimal treatment involves a combination of cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). Controversy persists regarding the pathological classification and its prognostic value. Computed tomography scanning is the optimal preoperative staging technique. Tumour marker elevations correlate with worse prognosis and increased recurrence rates. Following CRS with HIPEC, 5-year survival ranges from 62.5% to 100% for low grade, and 0%-65% for high grade disease. Treatment related morbidity and mortality ranges from 12 to 67.6%, and 0 to 9%, respectively. Surgery and HIPEC are the optimal treatment for PMP which is at best a "borderline" peritoneal malignancy.
ABSTRACT
AIM: The aim of this study was to review the incidence, presentation, diagnosis, and management of early port-site hernias (PSHs) in a single consultant surgeon's laparoscopic colorectal practice. METHOD: This work comprised a review of a prospectively maintained database to identify patients with a early PSH, with a subsequent review of the case notes. RESULTS: Overall, 401 laparoscopic colorectal procedures over a 64-month period were reviewed. The median age was 64 years (range, 18-95), and 54% were female. The incidence of early PSH was 0.75% (3/401) and occurred in port sites greater than 5 mm in size. In each case, a computed tomography scan was required for diagnosis and return to theater was necessary to repair the defect. In all patients, this complication resulted in considerable increase in postoperative stay with associated interventions. CONCLUSIONS: Awareness of the need to close the fascia in all ports over 5 mm, and the techniques available to do so, may reduce the incidence and decrease the morbidity associated with this potentially fatal complication associated with laparoscopic colorectal surgery.
