Recurrent inguinal hernia in a preschool girl treated laparoscopically with a preperitoneal transabdominal technique and polypropylene mesh: an alternative in complex cases.

We report the case of a 4-year-old girl treated by a laparoscopic transabdominal preperitoneal (TAPP) technique with polypropylene mesh in whom a primary contralateral hernia was found and repaired, closing the orifice with a suture. This 4-year-old female had a medical history of clubfoot treated by surgery during her first year of age, ureteral reimplantation because of stenosis, and laparoscopic cholecystectomy because of hydrocholecystis. She had recurrence 1 year after a conventional inguinal herniorraphy and was treated by the TAPP technique with polypropylene mesh. A primary contralateral hernia was found and repaired, and the orifice was closed with a suture. The child's acceptance of the procedure was good, and the postoperative evolution was uneventful, requiring minimal analgesia in the first 24 h. She was discharged the following day. Two years later, there have been no recurrences, and the girl is developing and carrying out activities in a normal way. The open technique remains the gold standard for hernioplasty in children, but laparoscopy may be an option, and it is possible that in some special cases, the use of mesh to reinforce the inguinal wall using the TAPP technique, although it is controversial, may be justified.

[Case report: laparoscopic cholecystectomy and common bile duct exploration in a 60 year-old patient with situs inversus]. / Colecistectomía con exploración de vías biliares laparoscópica en un paciente de 60 años con situs inversus; informe de un caso.

This is a case report of a 60 year-old male patient with acute cholecystitis and jaundice, unaware of having situs inversus. Patient underwent successfully laparoscopic cholecystectomy with bile duct exploration in spite of the unusual clinical situation. A literature review using Pubmed database, since 1989, in Spanish and English literature was performed. We found only two reports of cholecystectomy and common bile duct exploration in patients with situs inversus. This is the first case reported in our country.

[Analysis of the increasing role of laparoscopy in the management of acute abdomen in pregnancy]. / Análisis del papel creciente de la laparoscopia en el manejo del abdomen agudo durante el embarazo.

This is a review of the epidemiological, diagnostic and therapeutic aspects of acute abdominal conditions during pregnancy. We emphasize the recent changes in surgical criteria that have appeared since the advent of laparoscopic surgery. The incidence of acute appendicitis during pregnancy is 1 in every 1,500 while approximately 4.5% of pregnant women have asymptomatic cholelithiasis and 0.05% acute cholecystitis. Up to 40% of these patients will require surgery during gestation and it is well known that abdominal interventions in this period carry out a higher risk of miscarriage or premature labor. We analyze the most common causes of acute abdomen during pregnancy as well as the special considerations of conservative treatment, open surgery and laparoscopic surgery. We also review the technical aspects of laparoscopic procedures and the safety guidelines by the Society of American Gastrointestinal Endoscopic Surgeons. It is concluded that the laparoscopic approach is safe and effective in the diagnosis and treatment of acute abdominal pathology during pregnancy. The advantages over conventional open surgery have made many surgeons and gynecologists change their criteria in favor of laparoscopy and this is now often their first choice of treatment.

[Rectorrhagia as complication of Klippel-Trenaunay syndrome]. / Rectorragia como complicación del síndrome de Klippel-Trenaunay.

OBJECTIVE: To describe the clinical presentation and treatment of two patients with the Klippel-Trenaunay syndrome referred to our hospital because of rectal bleeding and to review the literature concerning the diagnosis and treatment of this complication. CASE 1: Fifteen year old male with the Klippel-Trenaunay syndrome and chronic anemia who presented with severe rectal bleeding. CASE 2: Nineteen year old female with the same syndrome and a two year history of intermittent rectal bleeding, anemia and thrombocytopenia. In both cases the study protocol revealed varicose lesions in the colon as the cause of bleeding and other vascular malformations related to their syndrome. TREATMENT: The first patient was treated with partial colectomy and colorectal anastomosis. Four years after surgery he presented with new episodes of bleeding and was treated with sclerosis of the residual rectal varices using formaldehyde. The second patient was treated with partial colectomy and colostomy. She has received to sessions of sclerosis with absolute alcohol of the residual varices in the rectal stump. Colostomy closure is soon to be performed. CONCLUSION: Klippel-Trenaunay syndrome is a rare clinical entity with vascular alterations at different levels. A small percentage of cases may present rectal bleeding due to colonic varices and can lead to chronic anemia or severe hemorrhage with hemodynamic implications. Treatment of this complication involves resection of the affected colonic segment combined with a secondary procedure to control bleeding of the residual rectal varices.