Laparoscopic management of inferior lumbar hernia (Petit triangle hernia).

Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8 x 10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference.

Laparoscopic resection of an esophageal epiphrenic diverticulum.

Epiphrenic diverticulum of the esophagus is an uncommon disease. In the light of the benefits of minimally invasive treatment of such a functional disorder, we used the laparoscopic approach for resection of an epiphrenic diverticulum. We found that laparoscopic repair of symptomatic esophageal epiphrenic diverticula is a safe and effective technique with minimal postoperative pain and morbidity. It should be considered as an alternative to the traditional transthoracic approach, and may become the standard technique.

Lack of evidence that obesity is a cause of pilonidal sinus disease.

OBJECTIVE: To find out whether pilonidal sinus is more common among obese people. DESIGN: Retrospective study from hospital records. SETTING: Two university hospitals, Turkey. SUBJECTS: 419 patients who were operated on for pilonidal sinus disease; and 213 age and sex matched patients with benign diseases other than pilonidal sinus disease and who were not morbidly obese acted as controls. MAIN OUTCOME MEASURES: Comparison of body mass index (BMI) in the two groups. RESULTS: Patients with BMI of 25-30 were classified as overweight (61/419, 15% compared with 28/213, 13%), and those with BMI of 30 or more as obese (7/419 compared with 4/213, 2% in each group). Mean (SD) BMI of patients with pilonidal sinus disease was 26.0 (3.9) compared with 25.6 (3.9) in the control group (p = 0.4). CONCLUSION: Obesity alone is not an important factor in the aetiology of pilonidal sinus disease.

Ectopic thyroid in the abdomen: report of a case.

Ectopic thyroid tissue can be seen anywhere along the path of the descending glands, but it is rarely seen in the abdominal cavity. An ectopic thyroid was encountered incidentally in the pancreas of a 50-year-old woman who underwent a bilateral truncal vagotomy and pyloroplasty for a duodenal ulcer. There were no signs or symptoms of a thyroid tumor.

Closed perforation of the small intestine showing continuity and the diagnostic role of enteroclysis.

BACKGROUND: Conventional abdominal CT and Ultrasonography were not adequate for the immediate assessment of a closed perforation of the small intestine showing continuity. For definitive diagnosis of the main pathology, we advise enteroclysis. METHODS: All patients had non-traumatic small bowel perforation and had many diagnostic procedures including conventional abdominal CT and ultrasonography, but did not get a positive result from them. Following the enteroclysis, it was obvious that there existed a closed small bowel perforation with continuity. RESULTS: The first patient had fistula and interloop pouch filled with contrast in pelvis minor and perforations in small intestine and cecum. The second patient had closed perforation showing continuity in the level of ileum and the third patient had a pouch showing continuity in the ileum and a fistula in ileum. All patients had operation; the first one had a Crohn's disease and discharged postoperatively on 16th day, but the second one having ileal tumor was lost postoperatively due to pulmonary embolism and the third one having Non-Hodgkin Lymphoma was lost postoperatively due to sepsis. CONCLUSION: Conventional techniques were not sufficient to classify the main pathology in these cases, but enteroclysis revealed good results in diagnosis of the main event, and does not cause a delay in diagnosis.

Management of intrabiliary rupture of hydatid cyst of the liver.

Thirty-six patients with intrabiliary rupture of hepatic echinococcal cysts were managed between 1974 and 1993. Clinical findings, skin tests, serologic tests, and imaging techniques were used to establish the diagnosis. Twenty-five (69.4%) patients had pain, 24 (66.6%) jaundice, 22 (61.1%) fever, 20 (55.5%) chills, 10 (27.7%) malaise, and 7 (19.4%) other symptoms as the major causes of admission. All patients underwent choledochotomy and T-tube drainage. Treatment directed to the cyst was cystectomy and capittonage, cystectomy and drainage, and partial hepatectomy in 22, 12, and 2 patients, respectively. Omentoplasty was added to the treatment in 10 patients. Seven (19.4%) patients had complications. The period of hospitalization for patients with and without complications was 34.6 +/- 18.1 and 15.1 +/- 2.7, days, respectively. This study indicates that better results are obtained in patients with cystic lesions of the liver by avoiding percutaneous puncture or biopsy, the early use of ultrasonography and computed tomography, evacuation of the cyst together with its germinative membrane and the involved biliary tract under adequate care to avoid spillage into the peritoneal cavity, treating the remaining cavity according to its location, size, and the presence of infection, and decreasing the pressure in the biliary tract by T-tube drainage.

Preliminary experience with a double-illumination technique for laparoscopic left colectomy.

This report describes our technique and initial experience with total intraabdominal laparoscopic left colectomy on 3 patients. Three consecutive patients, 2 females and 1 male, underwent laparoscopic left colectomy due to sigmoid volvulus and villous adenoma, respectively. The technique described herein helps to locate the intracolonic lesion, enables en bloc resection, shortens the operation time, and reduces the cost. Because the procedure is minimally invasive, patient recovery is remarkable compared with the conventional technique. All of the patients in this report were discharged on postoperative day 4 without any morbidity.