Subject(s)
Colonic Diseases , Intestinal Obstruction , Intussusception , Female , Humans , Aged, 80 and over , Intussusception/diagnostic imaging , Intussusception/etiology , Colon, Sigmoid , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Rectum , Colonic Diseases/complications , Colonic Diseases/diagnosisSubject(s)
Bacteremia , Colorectal Neoplasms , Streptococcal Infections , Bacteremia/complications , Bacteremia/diagnosis , Colorectal Neoplasms/complications , Colorectal Neoplasms/diagnosis , Humans , Streptococcal Infections/complications , Streptococcal Infections/diagnosis , Streptococcus gallolyticusABSTRACT
BACKGROUND: Transanal total mesorectal excision (taTME) represents a novel approach to rectal dissection. Although many structured training programs have been developed worldwide to assist surgeons in implementing this new technique, the learning curve (LC) of taTME has yet to be conclusively defined. This is particularly important given the concerns regarding the complication profile and oncological safety of taTME. The aim of this review was to provide an up-to-date systematic review and meta-analysis of the LC for taTME, comparing the difference of outcomes between the LC and after learning curve (ALC) groups. METHODS: An up-to-date systematic review was performed on the available literature between 2010-2020 on PubMed, EMBASE, Medline and Cochrane Library databases. All studies comparing taTME procedures before and after LC were analysed. RESULTS: Seven retrospective studies of prospectively collected databases were included, comparing 333 (51.0%) patients in the LC group and 320 (49.0%) patients in the ALC group. There was a significantly reduced number of adverse intra-operative events, anastomotic leaks and improved quality of mesorectal excision in the ALC group. CONCLUSION: This review shows that there is a significant improvement in clinical outcomes between the LC and ALC groups which supports the need for careful mastery and ongoing technical refinement during the LC in taTME. This procedure should be performed on a subset of carefully selected patients in the hands of experienced and well-trained teams dedicated to ongoing audit.
Subject(s)
Laparoscopy , Rectal Neoplasms , Transanal Endoscopic Surgery , Humans , Laparoscopy/adverse effects , Laparoscopy/methods , Learning Curve , Postoperative Complications/etiology , Rectal Neoplasms/complications , Rectal Neoplasms/surgery , Rectum/surgery , Retrospective Studies , Transanal Endoscopic Surgery/adverse effects , Transanal Endoscopic Surgery/methods , Treatment OutcomeSubject(s)
Appendiceal Neoplasms , Appendicitis , Appendix , Cecal Diseases , Fistula , Intussusception , Acute Disease , Adult , Appendiceal Neoplasms/complications , Appendicitis/complications , Appendicitis/diagnosis , Appendicitis/surgery , Cecal Diseases/complications , Cecal Diseases/diagnosis , Fistula/complications , Humans , Intussusception/diagnosis , Intussusception/etiology , Intussusception/surgerySubject(s)
COVID-19 , Operating Rooms/standards , Practice Guidelines as Topic , COVID-19/prevention & control , Humans , Pandemics , SARS-CoV-2Subject(s)
Duodenum , Nausea , Duodenum/diagnostic imaging , Humans , Nausea/etiology , Vomiting/etiologyABSTRACT
INTRODUCTION: A congenital diaphragmatic hernia (CDH) is rarely diagnosed in adults and can allow passage of abdominal viscera into the chest cavity. A particularly rare association is a wandering spleen due to absence of its diaphragmatic and retroperitoneal attachment which predisposes to elongation of the vascular pedicle with risk of torsion, infarction and rupture. PRESENTATION OF CASE: A 17-year-old girl presented with a two-day history of increasing abdominal pain. Examination identified an abdominal mass. Computer tomography (CT) chest, abdomen and pelvis revealed a significantly enlarged wandering spleen with signs of torsion and an associated large left CDH with viscera in the chest cavity. The patient proceeded to an open splenectomy and repair of CDH. Post-operatively the patient developed ileus and required a temporary chest tube for pneumothorax, but otherwise progressed well. DISCUSSION: Untreated CDH with a symptomatic wandering spleen is an extremely rare diagnosis with only one similar previous case report. Clinical detection is unlikely, making CT scanning the diagnostic test of choice. Surgery is recommended given the high morbidity and mortality of associated complications of both conditions. Splenic preserving options are favoured, however the majority of identified cases require splenectomy because of associated torsion or splenomegaly. Reduction of the CDH should be performed with primary closure of the defect and mesh reinforcement where possible. CONCLUSION: CDH with associated wandering spleen in adults presents an extremely rare but clinically important diagnosis. Prompt surgical management as reported in this case should be performed to minimise immediate and future complications.
ABSTRACT
This study summarizes the steps in laparoscopic extended view totally extraperitoneal ventral hernia repair with mesh in retrorectus space.
Subject(s)
Hernia, Inguinal , Hernia, Ventral , Laparoscopy , Hernia, Inguinal/surgery , Hernia, Ventral/surgery , Herniorrhaphy , Humans , Prostheses and Implants , Surgical MeshABSTRACT
This study describes the technique for extended view totally extraperitoneal hernia repair.
