A Foreign Body in an Unexpected Place-Ingested Hardware Nails Within the Appendix.

Foreign body ingestion is commonly encountered in clinical practice, with over 100,000 cases reported annually in the United States. The majority of objects pass through the gastrointestinal tract spontaneously and without consequence, with fewer than 1% of objects requiring surgical intervention. Foreign bodies have rarely been found lodged within the appendix. We report the therapeutic management of a young patient who ingested over 30 hardware nails. The patient originally underwent an esophagogastroduodenoscopy with attempted removal from the stomach and duodenum, though only 3 nails were successfully extracted. The patient was able to excrete all but 2 of the nails that remained localized to the right lower quadrant without perforation to their gastrointestinal tract. Laparoscopic exploration with fluoroscopic guidance was performed and both foreign bodies were found lodged within the appendix. The patient made an uneventful recovery after laparoscopic appendectomy.

Comparison of open and laparoscopic prosthetic repair of large ventral hernias.

BACKGROUND AND OBJECTIVES: Open ventral hernia repair is associated with significant morbidity and high recurrence rates. Recently, the laparoscopic approach has evolved as an attractive alternative. Our objective was to compare open with laparoscopic ventral hernia repairs. METHODS: Fifty laparoscopic and 22 open ventral hernia repairs were included in the study. All patients underwent a tension-free repair with retromuscular placement of the prosthesis. No significant difference between the 2 groups was noted regarding patient demographics and hernia characteristics except that the population in the open group was relatively older (59.4 vs 47.82, P < 0.003). RESULTS: We found no significant difference in the operative time between the 2 groups (laparoscopic 132.7 min vs open 152.7 min). Laparoscopic repair was associated with a significant reduction in the postoperative narcotic requirements (27 vs 58.95 mg i.v. morphine, P < 0.002) and the lengths of nothing by mouth (NPO) status (10 vs 55.3 hrs. P < 0.001), and hospital stay (1.88 vs 5.38 days, P < 0.001). The incidence of major complications (1 vs 4, P < 0.028), the hernia recurrence (1 vs 4, P < 0.028), and the time required for return to work (25.95 vs 47.8, P < 0.036) were significantly reduced in the laparoscopic group. CONCLUSIONS: Laparoscopic ventral hernioplasty offers significant advantages and should be considered for repair of primary and incisional ventral hernias.

Experiencia quirúrgica en el pseudoquiste pancreático (cisto-yeyunoanastomisis en Y de Roux) / Experience with surgical treatment of the pancreatic pseudocysts

Estudio observacional, descriptivo, retrospectivo con el objetivo de evaluar los resultados del tratamiento quirúrgico del pseudoquiste pancreático, durante el tiempo comprendido entre marzo de 1996 a noviembre de 2003. La edad promedio fue 34,4 años, (13/57). Cinco fueron varones (62,5pto) y 3 mujeres (37,5pto). La etiología fue biliar (n:5), post traumática (n:2) e idiopática en un caso. La ecografía y la TAC abdominal fueron diagnósticas en el 100 pto. de los casos. La cirugía realizada fue biopsia extemporánea intraoperatoria y cisto yeyunoanastomosis en Y de Roux en todos ellos, con colecistectomía en los casos biliares. Una colección purulenta de la herida como morbilidad y una mortalidad operatoria, por embolia pulmonar, no relacionada a la técnica de cirugía. En el seguimiento de éstos pacientes 2/60meses), no se ha constatado complicaciones. Se concluye que el manejo quirúrgico (cisto-yeyunoanastomosis en Y de Roux) fue con excelentes resultados.

Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation.

BACKGROUND: Minimally invasive laparoscopic nephrectomy is a well-established alternative to open surgery in living donors for kidney transplantation. Donor mortality and morbidity rates as well as recipient outcome are comparable to the open approach. Furthermore, the procedure is associated with reduced donor discomfort, faster recovery, and improved cosmetic results. Recently, an advanced robotic system for laparoscopic surgery was approved for use in the United States. This system allows a greater freedom of movement and recreates the hand-eye coordination and three-dimensional vision that is lost in standard laparoscopic procedures. METHODS: We report the first 12 successful cases of robotic-assisted laparoscopic living donor nephrectomy performed using the da Vinci Surgical System (Intuitive Surgical, Mountain View, CA). RESULTS: Our initial experience has shown that the system allows the performance of donor nephrectomy in a safe and accurate fashion. CONCLUSIONS: As technology continues to evolve, robotic-assisted surgery has the potential to become a widely used attractive alternative to standard laparoscopic donor nephrectomy.

Early experience with robotically assisted laparoscopic donor nephrectomy.

The da Vinci robotic system became available at our institution in late August 2000. We decided to use this system to perform robotically assisted laparoscopic donor nephrectomies. A prospective study was conducted of 10 consecutive patients who underwent robotically assisted laparoscopic donor nephrectomy between January and May 2001. The mean operative time was 166 minutes. The mean hospital stay was 1.8 days. The need for parenteral pain medication was limited to the first postoperative day. All kidneys were transplanted successfully; no rejections occurred. This early experience suggests that the results of robotically assisted laparoscopic donor nephrectomy are similar to those of laparoscopic donor nephrectomy. We believe that robotic surgery, which enables regaining of the hand-eye coordination and three-dimensional view lost in laparoscopic surgery, allows us to perform the donor nephrectomy with greater precision, confidence, and comfort.

Outcome of laparoscopic ventral hernia repair in correlation with obesity, type of hernia, and hernia size.

BACKGROUND: The morbidity and overall recovery time of ventral hernia repair can vary significantly depending on the hernia type or size and on other factors, such as the body mass index (BMI). The purpose of our study was to investigate the effects of type of hernia, hernia size, and BMI on the outcome of laparoscopic ventral hernia repair. METHODS: Fifty patients who underwent laparoscopic ventral hernia repair were retrospectively reviewed and stratified according to hernia type (incisional, IVH/primary, PVH), hernia size, and BMI. These subgroups were compared in regard to operative time, resumption of diet, hospital stay, pain control, and complication rate. RESULTS: Laparoscopic IVH repair was associated with a longer operative time (143 vs. 98 minutes, p = .02) and length of stay (2.2 vs. 0.6 days, p = .03) than PVH repair. The narcotic requirements were higher in the IVH group, but the difference did not reach statistical significance. Larger hernias were associated with a longer operative time (p = .04) and increased narcotic requirement (p = .03). The morbidity of the laparoscopic repair was not significantly affected by the hernia type or size. The BMI did not significantly alter any of the parameters examined. CONCLUSIONS: Laparoscopic repair of incisional and larger hernias is a technically demanding procedure that requires a longer operative time. In contrast to PVH repair, laparoscopic IVH repair usually cannot be performed on an outpatient basis. Surgeons need not be discouraged from recommending the laparoscopic approach for patients with large IVHs or with severe obesity because the morbidity remains low.