Laparoscopic total extra-peritoneal inguinal hernia repairs by a surgeon experienced at laparoscopic cholecystectomy.

OBJECTIVE: To measure standards achieved at total extra peritoneal hernia repair by a surgeon experienced in laparoscopic cholecystectomy, and to compare the results with standards identified by the National Institute for Clinical Excellence. METHODS: The outcomes of the first 100 consecutive total extra-peritoneal hernia repair cases by the surgeon were retrieved retrospectively. The surgeries were conducted between January 2006 and July 2007. Data was collected 14 to 17 months post-surgery. RESULTS: All patients were men with a median age of 58 years, ranging from 20 to 91 years. The maximum operating time was 75 minutes, while the minimum was 30 minutes. The conversion rate was 3% (n = 3) and the recurrence rate 4% (n = 4). Complications experienced included a chronic groin pain and one umbilical port-site haematoma. CONCLUSION: Though related to a single-surgeon experience, the study highlighted reduced preceptorship due to previous laparoscopic skills that were transferable. Patients should have a choice to opt for either open or laparoscopic inguinal hernia repair.

Pelvic vein embolisation in the management of varicose veins.

Pelvic vein incompetence is common in patients with atypical varicose veins, contributing to their recurrence after surgery. Therefore, refluxing pelvic veins should be identified and treated. We present our experience with pelvic vein embolisation in patients presenting with varicose veins. Patients presenting with varicose veins with a duplex-proven contribution from perivulval veins undergo transvaginal duplex sonography (TVUS) to identify refluxing pelvic veins. Those with positive scans undergo embolisation before surgical treatment of their lower limb varicose veins. A total of 218 women (mean age of 46.3 years) were treated. Parity was documented in the first 60 patients, of whom 47 (78.3%) were multiparous, 11 (18.3%) had had one previous pregnancy, and 2 (3.3%) were nulliparous. The left ovarian vein was embolised in 78%, the right internal iliac in 64.7%, the left internal iliac in 56.4%, and the right ovarian vein in 42.2% of patients. At follow-up TVUS, mild reflux only was seen in 16, marked persistent reflux in 6, and new reflux in 3 patients. These 9 women underwent successful repeat embolisation. Two patients experienced pulmonary embolisation of the coils, of whom 1 was asymptomatic and 1 was successfully retrieved; 1 patient had a misplaced coil protruding into the common femoral vein; and 1 patient had perineal thrombophlebitis. The results of our study showed that pelvic venous embolisation by way of a transjugular approach is a safe and effective technique in the treatment of pelvic vein reflux.

Coil protruding into the common femoral vein following pelvic venous embolization.

Pelvic venous embolization is performed for pelvic congestion syndrome and prior to lower limb varicose vein surgery in females with associated pelvic venous insufficiency. The procedure is analogous to varicocele embolization in males, although refluxing internal iliac vein tributaries may also be embolized. We report a case of inadvertent coil placement in the common femoral vein while embolizing the obturator vein, during pelvic vein embolization for recurrent lower limb varicose veins. There were no clinical consequences and the coil was left in situ. We advise caution when embolizing internal iliac vein tributaries where there is clinically significant communication with veins of the lower limb.