ABSTRACT
BACKGROUND: The femoral hernia, the least common of all groin hernias, is seen most frequently in females. The main techniques for repair are femoral, inguinal and extraperitoneal Cheatle-Henry techniques. With laparoscopic surgery, total extraperitoneal technique is done with a patch to cover the femoral ring. We undertook this study to present the experience with the Cheatle-Henry operation for treatment of femoral hernia. METHODS: The study took place at the ABC Hospital, a third-level care institution in Mexico City. The study design was retrospective, observational, and descriptive. Medical records of patients with femoral hernias treated by the authors during a 27-year period utilizing the Cheatle-Henry operation were analyzed. RESULTS: Thirty-nine patients with femoral hernia treated with the Cheatle-Henry operation were found. There were 34 females (87.2%) and five males (12.8%) with an average age of 48 years, (range: 18-84 years). Hernia was more common on the right side with 31 cases (79.48%). Elective surgery was done in 26 cases (66.65%) and emergency operations were done in 13 patients (33.53%). There was no morbidity/mortality. CONCLUSIONS: Cheatle-Henry operation is a safe and secure technique to operate on femoral hernia, which is the least common of all groin hernias.
Subject(s)
Hernia, Femoral/surgery , Herniorrhaphy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Elective Surgical Procedures , Emergencies , Female , Hernia, Femoral/epidemiology , Humans , Ligaments/surgery , Male , Middle Aged , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Suture Techniques , Young AdultABSTRACT
BACKGROUND: Lipomas are the most frequent benign tumors of the digestive tract and 50% are localized in the colon. Most are found submucosally and may vary in their incidence, localization, symptoms and pathogenesis, making diagnosis difficult. We undertook this study to learn the different presentations of an ileocecal valve (ICV) lipoma and conduct a review of the literature due to this uncommon location. CASE PRESENTATION: We present the case of a 78-year-old female with intermittent small bowel occlusion, abdominal distention and constipation. Colonoscopy showed a submucous tumor at the ICV, CT scan showed a tumor at the ICV with fat density. Laparotomy was performed with primary resection of the lesion by cecotomy, frozen section was reported as nonmalignant so a primary closure without ICV involvement was achieved. Definitive pathology revealed a benign lipoma. CONCLUSION: It is important to know the different presentations of these benign tumors because if there is mucosal ulceration they can be mistaken for a malignant lesion and lead to greater resections. Resection is necessary if they are symptomatic or >2 cm.
Subject(s)
Ileal Neoplasms/diagnosis , Ileocecal Valve , Lipoma/diagnosis , Aged , Female , Humans , Ileal Neoplasms/complications , Ileal Neoplasms/surgery , Intestinal Obstruction/etiology , Lipoma/complications , Lipoma/surgeryABSTRACT
BACKGROUND: Laparoscopic fundoplications are the standard surgical treatment of patients with gastroesophageal reflux disorder. Adequate technique is the most important outcome factor. There is no standardized method to evaluate the procedure itself. Intraoperative endoscopy is a method to evaluate laparoscopic fundoplications. MATERIAL AND METHODS: This was a retrospective observational study of patients undergoing laparoscopic fundoplications from July 1999 to June 2004, excluding open procedures and reoperations of previous failed laparoscopic fundoplications. Intraoperative endoscopy was performed during the dissection and suturing of the procedure to determine if correction of the technique is necessary. Number of changes were recorded and analyzed with Student's t-test. RESULTS: Three hundred patients were operated on, 23 were excluded (14 reoperations and nine conventional laparotomies). Of the 277 patients included, 178 were males and 99 females. Average age was 43.4 +/- 14 years (range: 12-85). There were 71 Toupet and 206 Nissen fundoplications. Intraoperative endoscopy determined correction of the technique in 77 patients with 1.69 +/- 0.96 changes; 68 rotated and/or angled fundoplications, one rotation with distended stomach, one redundant gastric fundus, and seven change in the type of fundoplication from Nissen to Toupet because of tightness (3.7 +/- 1.1 changes, p = 0.0001) to achieve adequate fundoplication. CONCLUSIONS: Intraoperative endoscopy confirms adequate technique and prevents inadequate laparoscopic fundoplications. Further studies will determine if routine use is justified to prevent postoperative complications and to improve outcome.
Subject(s)
Fundoplication/methods , Gastroesophageal Reflux/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Intraoperative Care , Laparoscopy , Male , Middle Aged , Postoperative Complications , Reoperation , Retrospective Studies , Treatment OutcomeABSTRACT
Introducción: los lipomas son los tumores benignos más frecuentes en tubo digestivo y hasta 50 % se encuentra en el colon. La mayoría son submucosos y varían de acuerdo a su incidencia, localización, sintomatología y patogénesis, lo que dificulta su diagnóstico. Nuestro objetivo fue conocer las diferentes manifestaciones clínicas causadas por un lipoma en la válvula ileocecal, y hacer una revisión de la literatura de esta localización poco frecuente. Caso clínico: mujer de 78 años que presentó cuadros repetidos de oclusión intestinal parcial con distensión abdominal, constipación y obstipación. Se realizó colonoscopia que mostró tumoración submucosa de 30 mm en válvula ileocecal; la tomografía computarizada de abdomen mostró tumoración nodular de densidad grasa en válvula ileocecal. La paciente fue sometida a laparotomía exploradora y cecotomía, donde se identificó y resecó tumoración submucosa, la cual fue enviada a estudio transoperatorio; dado que se trató de una tumoración benigna, se respetó la válvula ileocecal y se realizó cierre primario. El reporte histopatológico definitivo fue lipoma, negativo para malignidad. Conclusiones: es importante conocer las distintas formas de presentación de los lipomas, ya que fácilmente pueden confundirse con lesiones malignas (sobre todo si existe ulceración de la mucosa) y someter al paciente a procedimientos mayores. Sólo deben resecarse si producen síntomas o son mayores a 2 cm.
BACKGROUND: Lipomas are the most frequent benign tumors of the digestive tract and 50% are localized in the colon. Most are found submucosally and may vary in their incidence, localization, symptoms and pathogenesis, making diagnosis difficult. We undertook this study to learn the different presentations of an ileocecal valve (ICV) lipoma and conduct a review of the literature due to this uncommon location. CASE PRESENTATION: We present the case of a 78-year-old female with intermittent small bowel occlusion, abdominal distention and constipation. Colonoscopy showed a submucous tumor at the ICV, CT scan showed a tumor at the ICV with fat density. Laparotomy was performed with primary resection of the lesion by cecotomy, frozen section was reported as nonmalignant so a primary closure without ICV involvement was achieved. Definitive pathology revealed a benign lipoma. CONCLUSION: It is important to know the different presentations of these benign tumors because if there is mucosal ulceration they can be mistaken for a malignant lesion and lead to greater resections. Resection is necessary if they are symptomatic or >2 cm.
