Adolescent inguinal hernia repair: a review of the literature and recommendations for selective management.

BACKGROUND: The choice of how to repair inguinal hernias in adolescents has historically been a matter of experience and differed between pediatric surgeons who traditionally performed a high ligation of the sac and general surgeons who typically perform a repair using mesh. This up-to-date review thoroughly examines the subject and discusses the suitability of both types of repairs in this unique age group. METHODS: A 20-year Pub Med search was performed for the following terms: adolescent hernia repair including reports of mesh hernia repair in adolescents and postoperative complications including chronic inguinal pain and recurrences. RESULTS: The evidence in the literature suggests that while there appears to be no difference between the two types of repairs with regards to recurrence and complications, changes in the pelvic floor physiology in adolescents suggest that a selective, individualized approach can be recommended depending on the size and nature of the presenting pathology. CONCLUSIONS: A selective approach to the inguinal hernia in adolescent patients based on the size of the defect appears justified.

Robot-assisted adrenalectomy: a technical option for the surgeon?

BACKGROUND: The robotic approach is an interesting option for overcoming the limitations of laparoscopic adrenalectomy. We aimed to report our technique and outcomes of robot-assisted adrenalectomy (RAA). METHODS: From November 2000 to February 2010, all consecutive patients who underwent a RAA by the same surgeon were prospectively entered into a dedicated database. The data were reviewed retrospectively. RESULTS: During the study period, 21 right (50%), 20 left (47.6%) and 1 bilateral (2.4%) RAA were performed. Mean lesion size was 5.5 cm (max. 10 cm). Mean operative time was 118 ± 46 min and median blood loss was 27 ml. There were no conversions. The postoperative morbidity rate was 2.4%; mortality rate, 2.4%; median hospital stay, 4 days. CONCLUSIONS: RAA achieves good short-term outcomes and could be considered a valid option for the treatment of adrenal masses, with the potential to expand the limits of minimally invasive surgery.

Rare combination of spinal lesions and subcutaneous meningioma in a 44 year old man.

A 44 year-old man with subcutaneous meningioma and rare combination of spinal lesions, consisting of dermal sinus and lipoma of the filum terminale. The literature concerning the subcutaneous meningioma is reviewed and the embryogenesis of these lesions is discussed.

Intravenous administration of high doses of carboplatin in multimodal treatment of high grade gliomas: a phase II study.

The object of this study is to evaluate the efficacy of a high dose of carboplatin in 20 patients operated on for high grade glioma (Group A) compared with a matched control (Group B) treated with BCNU administered after radiotherapy. The toxicity profile has been evaluated during the therapy. The survival of patients entering this study was measured in terms of months: the mean survival time was 10.45 months and the median 11.0 months in the group treated with carboplatin (8 patients are still alive); the 18-month survival rate was 10%. The mean survival time of the control group was 9.85 months and the median 10.5 months; no patients are still alive and the 18-month survival rate was 0%. On the basis of our phase II clinical study, we could conclude that i.v. administration of high-doses of carboplatin in high grade gliomas is generally well tolerated and the results are better than those of a matched control treated with 1-2 courses of BCNU (low-dose). The adjuvant treatment and the role of carboplatin in the therapy of high grade gliomas is discussed.