Laparoscopic indirect hernia repair: an evaluation of the ring closure technique.

BACKGROUND: The treatment of indirect inguinal hernias offers a wide variety of surgical methods to choose from. The author has chosen the procedure combining most of the advantages and the fewest disadvantages while at the same time being simple. It entails a simple closure using laparoscopic intraperitoneal intracorporeal suturing of the defect (the internal ring) with nonabsorbable material. PATIENTS AND METHODS: Forty-eight hernias were treated by laparoscopic intracorporeal closure of the internal ring using nonabsorbable suture. No mesh was used. The mean age of the patients was 41.9 years with a mean duration of symptoms of 44.9 months. The mean operating time was 67 minutes per hernia, and the postoperative hospitalization was 1.9 days. The mean follow-up was 32.67 months. RESULTS: Only one hernia recurred (2%). None of the patients developed serious complications, and only 10 patients complained of port site discomfort. CONCLUSIONS: Our results indicate that the laparoscopic internal ring closure method is simple, safe, and effective in treating indirect inguinal hernias. In addition, it appears to be cost effective.

Role of fine needle aspiration biopsy in the management of thyroid nodules.

OBJECTIVE: To evaluate the degree of utilisation, the accuracy and the effect of fine needle aspiration biopsy (FNAB) in patients with nodular thyroid lesions. DESIGN: Cross-sectional study. SETTING: King Khalid University Hospital, Riyadh, Saudi Arabia. SUBJECTS: Four hundred and twenty eight patients with thyroid lesions who were treated surgically were reviewed. The FNAB of 201 patients were compared with the post-operative histopathological findings. RESULTS: Most of the patients (69%) presented with nodular thyroid disease (solitary and multinodular) and among this group 31.4% did not undergo FNAB pre-operatively. In more than 76%, the FNAB resulted in a definite cytologic diagnosis. A sensitivity of 71.4% and a specificity of 96.4% was achieved. CONCLUSION: If FNAB were used routinely in the initial evaluation of patients with thyroid nodules it could have an enormous effect on their management. It reduces the number of patients going for thyroidectomy and eliminates the need for nuclear scans to screen patients with thyroid nodules. Therefore, we recommend FNAB to be part of the initial evaluation of all patients with nodular thyroid disease.

Laparoscopic removal of a foreign body from the intestine.

Foreign bodies are often introduced into the gastrointestinal tract of both adults and children. At times this is intentional and at others it is accidental. The doctor is usually faced with the problem of deciding whether to apply expectant treatment, endoscopy or surgery to obtain an optimum outcome. The management depends on the type of object, the organ affected, the type of symptoms and the condition of the patient in deciding if, when and how to intervene. A case is reported here where a method not previously described was used to retrieve a sewing needle from the distal ileum.

Symptomatic gallstones: a disease of young Saudi women.

This is a study performed to identify the risk factors for gallstones in Saudis, taking the patient population of King Khalid University Hospital as a sample. Only Saudis with symptomatic gallstones were studied, the parameters being age, sex, weight, body mass index, fertility, age at menarche and age at marriage. The results showed that sex, weight, body mass index and fertility all appeared to be important factors in the development of gallstones and that the condition affects more Saudi females and at a younger age than reported in the literature, probably due to overweight and factors related to reproductivity. We conclude that gallstones are common in Saudi women and affect them at a younger age than western women, weight and fertility appear to be important risk factors.

Hemorrhoids! Don't call the surgeon yet.

Two hundred and twenty-four consecutive patients seen for the first time with symptomatic hemorrhoids were given a high fiber diet supplemented by ispaghula husk. Patients were seen at 1, 3, 6 and 12 months and showed improvement. The results suggest that conservative treatment using only a high fiber diet supplemented by Metamucil is highly effective in the symptomatic treatment of patients with piles.

The postcholecystectomy syndrome: a review.

The objective is to study the Postcholecystectomy Syndrome (PCS); its causes, different methods of diagnosis and different treatment options and their results in order to deduce from the above data the best method of prevention of its occurrence and the best method of treatment once it has occurred. Data sources include a medline search of articles covering this topic in the English literature and the abstracts of non-English articles from 1966-1994. The total number of articles of interest to the study being approximately 120. There are many causes of PCS, some related to improper preoperative diagnosis and some related to avoidable and unavoidable consequences of cholecystectomy. The different diagnostic modalities are dependent on the cause as are the different treatment options. The best treatment of this condition remains prevention whenever possible. Proper diagnosis of those patients who truly require cholecystectomy and care in performing the cholecystectomy will minimize the incidence of this syndrome.