Laparoscopic trans-peritoneal hernioplasty (TAPP) for the acute management of strangulated inguino-crural hernias: a report of nine cases.

BACKGROUND: Inguinal hernioplasty has always been one of the most commonly performed operations in clinical practice. In the last 15 years, thanks to the development of mini-invasive surgery, new video-endoscopic techniques for the treatment of inguinal hernia using trans-peritoneal (TAPP) and extraperitoneal (TEP) access have emerged. Both have a definite role in the treatment of bilateral and recurrent hernias, while the debate is still open about the treatment of primary mono-lateral hernias. In acute incarcerated hernia requiring an emergency operation, the endoscopic approach is uncommon and controversial, and even considered contraindicated. The aim of this publication is to verify the efficacy and the technical feasibility of TAPP operation by analyzing a consecutive series of patients operated on for incarcerated inguino-crural hernia associated with suspected visceral ischemic lesion in an emergency setting. MATERIALS AND METHODS: From September 2004 to October 2005, 13 patients were operated on acutely for inguino-crural incarcerated hernia associated with suspected visceral ischemic damage. Four were excluded from the endoscopic treatment due to anesthesiologic contraindications or huge hernia dimensions. Nine patients were operated on using a trans-peritoneal approach (TAPP). Visceral mobilization and hernia reduction were obtained by incision and opening of the hernia ring. Visceral resection was performed in one case with intestinal ischemia following a prolonged observation time or "test time." RESULTS: One case was associated with intestinal resection and incisional hernia repair, one with obturator hernia repair, and one with hepiployc appendix repair. None of the cases were converted to open technique, and no intra- or postoperative complications were recorded. Mean operative time was 72 min (35-180); mean hospital stay was 2.7 days (1-8). No recurrences were observed after a mean follow-up time of 18 months (8-24). CONCLUSIONS: The TAPP procedure can be proposed for emergency treatment of inguino-crural incarcerated hernias, allowing not only hernia correction, but also visual control and the contestual treatment of the hernia content. TAPP is a more challenging procedure compared to the traditional open anterior approach and therefore requires an adequate laparoscopic training. Exclusion criteria are constituted by anesthesiologic contraindications or dimensional criteria of the hernia.

[Videothorascopic treatment of benign tumors of the chest wall. Report of a case of neurilemmoma]. / Trattamento videotoracoscopico dei tumori benigni della parete toracica. Rapporto su di un caso di neurilemmoma.

Intercostal nerve sheat tumors are rare and normally benign tumors. The successful thoracoscopic resection of an intercostal neurilemmoma is reported. It occurred in an asymptomatic 44 year-old woman. Diagnostic flowchart consisted in an enhanced CT of the chest and in a fine needle biopsy under CT guidance of the chest wall mass. The videothoracoscopic resection was carried out with three small incisions, in a relatively brief time and without high technical difficulties. Postoperative course was uneventful and the patient was discharged in the fourth postoperative day. In authors' opinion thoracoscopic approach is actually mandatory as a first attempt to cure benign neurogenic tumors of the chest wall.

[Carcinoids in emergency surgery]. / I carcinoidi nell'urgenza chirurgica.

The authors report their experience of three cases of carcinoids of the gastroenteric tract which required emergency surgery. Two patients presented symptoms of acute appendicitis caused by appendicular carcinoid, whereas the third presented an occlusive syndrome due to ileal carcinoid.