[Internal herniationand ileus caused by intestinal malrotation and Ladd's band in an adult].

Midgut malrotation and internal herniation due to Ladd's band in adults is sparsely described. Due to the low incidence and the uncharacteristic symptoms, the diagnosis and treatment is often delayed causing increased morbidity. In this case report, a 68-year-old man was hospitalised with severe abdominal pain. A computed tomography showed abnormal placement of the small bowel loops and torsion of the small bowel mesentery. He underwent a laparoscopic procedure which revealed internal herniation due to a Ladd's band. He recovered uneventfully, and an elective Ladd's procedure was scheduled.

[Pre- and intra-operative methods of increasing abdominal compliance in surgery of ventral hernias].

Treatment of ventral hernias with "loss of domain" is a surgical challenge, and in this review, an overview of the current literature is presented. Abdominal compliance can be increased intra-operatively by performing component separation and/or organ reduction but leads to increased post-operative morbidity. As a result, preoperative methods, which increase abdominal compliance, are of interest: tissue expanders, progressive pneumoperitoneum, and botulinum toxin A. The aim of them all is to expand the abdominal wall allowing reconstruction while reducing complications.

Effect of fixation devices on postoperative pain after laparoscopic ventral hernia repair: a randomized clinical trial of permanent tacks, absorbable tacks, and synthetic glue.

PURPOSE: The method of anchoring the mesh in laparoscopic ventral hernia repair is claimed to cause postoperative pain, affecting the quality of life of the patients. The aim of this randomized study was to compare the effect of three types of fixation devices on postoperative pain, patient quality of life, and hernia recurrence. METHODS: Patients with ventral hernias between 2 and 7 cm were randomized into one of three mesh fixation groups: permanent tacks (Protack™), absorbable tacks (Securestrap™), and absorbable synthetic glue (Glubran™). The primary endpoint was pain on the second postoperative day, measured on a visual analogue scale. Quality of life and recurrence rate were secondary endpoints and investigated through questionnaires and clinical examination at follow-up visits 1, 6, and 12 months after surgery. RESULTS: Seventy-five non-consecutive patients were included in the study, with 25 patients in each group. There was no significant difference between groups for unspecified pain on the second postoperative day (p = 0.250). The DoloTest™ values were 55.3 ± 28.9 mm, 43.5 ± 28.5 mm, and 55.9 ± 26.3 mm for permanent tacks, absorbable tacks, and synthetic glue, respectively. No differences were observed between groups with respect to quality of life of the patients and hernia recurrence rate. CONCLUSIONS: In patients with small- and medium-sized ventral hernias, the type of fixation device did not affect the immediate or long-term postoperative pain, quality of life, or recurrence rate when comparing permanent tacks, absorbable tacks, and synthetic glue for mesh fixation. TRIAL REGISTRATION: NCT01534780.

Noninvasive detection and mapping of intraabdominal adhesions: a review of the current literature.

BACKGROUND: Adhesions are a well-known and very common complication to surgery. Their extent and severity varies according to type and number of surgeries, use of intraabdominal mesh, and presence of peritonitis. Adhesions cause increased morbidity and mortality, with subsequent socioeconomic consequences. This review aimed to identify existing literature on noninvasive radiologic techniques for identification of intraabdominal adhesions. METHODS: A structured literature search of medical databases was conducted. English literature published until September 2009 and relevant references were included and assessed. RESULTS: The search identified transabdominal ultrasonography (TAU) and cine magnetic resonance imaging (cine MRI) as relevant tools matching the search criteria. In all, 12 publications concerning TAU and 4 publications concerning cine MRI were identified. All but one of these publications had the methodologic limitation of not being blinded, which influenced the final sensitivity, specificity, and accuracy. CONCLUSION: Both TAU and cine MRI seem able to identify intraabdominal adhesions using visceral slide with accuracy of 76% to 92%. Unfortunately, the studies are biased by being nonblinded. Accordingly, a need exists for a systematic well-conducted double-blinded comparative study to validate these radiologic techniques.

Detection of abdominal wall adhesions using visceral slide.

BACKGROUND: Abdominal surgery, peritonitis, and pelvic inflammatory disease often give rise to intra-abdominal adhesions. They may lead to chronic pain, infertility, bowel obstruction, etc. Development in surgical strategies in the last decade has resulted in an increase in laparoscopic procedures and, as a consequence, a steep rise in reported bowel lesions. Accordingly, noninvasive diagnostic tools are desirable to identify adhesions before abdominal surgery. This study was designed to validate transabdominal ultrasonography (TAU) and magnetic resonance imaging (cine MRI) for detection of abdominal wall adhesions. METHODS: Sixty patients scheduled for laparoscopic surgery were prospectively enrolled. They were divided into two groups of 30 each; previous abdominal surgery/peritonitis and no history of abdominal surgery/peritonitis. Before elective surgery, TAU and cine MRI were performed. Visceral slide was measured in nine predefined abdominal segments and compared with intra-operative data on abdominal wall adhesions. Results were obtained in a double-blinded fashion. RESULTS: Patient characteristics were similar in both groups. Cine MRI showed a sensitivity, specificity, and accuracy of 21.5%, 87.1%, and 72.4%. TAU showed a sensitivity, specificity, and accuracy of 24%, 97.9%, and 81.3%. Comparison of TAU and cine MRI showed no significant difference in the detection of adhesions to the abdominal wall; however, TAU was significantly superior in depicting adhesion-free areas. CONCLUSIONS: This study represents the first comparative study of TAU and cine MRI as noninvasive methods in detecting adhesions to the abdominal wall. Both methods are specific in detecting adhesion-free areas, and may serve as a diagnostic tool for future planning of laparoscopic surgery, elucidation of adhesion-related symptoms, and as a tool in the follow-up after ventral hernia repair with implantation of intraperitoneal mesh.

[Laparoscopic mesh repair of incisional hernia]. / Laparoskopisk operation for incisionelt hernie.

Ventral hernias and their surgical treatment have long been a therapeutical problem. High recurrence and complication rates have caused surgeons to refrain from performing this type of surgery, often by enforcing strict indications for surgical management. With the introduction of laparoscopic mesh repair, we now have an effective and relatively simple and safe treatment modality at our disposal. In other words, it is a completely new ballgame with a different set of rules, and in the coming years a number of pertinent questions need to be asked and answered.

[Adhesion after laparoscopic ventral hernia repair]. / Adhaerencer efter laparoskopisk ventralherniotomi.

Four patients treated laparoscopically for ventral hernia (LVH) using W3 mesh (Cousin Biotech, France) and Protack (Tyco Healthcare, USA) were reoperated laparoscopically after 5, 6, 14 and 23 months for recurrent hernia (two cases) and a new hernia proximal to the primary mesh (two cases). In all patients we found adhesions toward the mesh and fixation devices that increased in severity and extent with time, rendering dissection difficult and dangerous. These findings cause concern and suggest that current validation methods for materials used in LVH should be re-evaluated.

[Chest pain caused by pancreatic pseudocyst located in the mediastinum]. / Brystsmerter forårsaget af mediastinal beliggende pancreaspseudocyste.

Mediastinal pancreatic pseudocyst is a rare condition, causing pulmonary, cardiac or oesophageal symptoms. We present a case of a mediastinal pancreatic pseudocyst in a 31-year-old male patient who was admitted on suspicion of having an acute myocardial infarction because of retrosternal pain. Diagnosis was achieved by CT scan, and the pseudocyst was treated by percutanous drainage. The patient recovered well with no further need of intervention.