Closing peritoneal tear during laparoscopic inguinal hernia repair: simple and effective technique.

PURPOSE: Peritoneal tears occurring during TAPP and TEP are common, and can cause difficulty in continuing surgery, or, if left open can cause postoperative complications. A number of techniques to close the tear in the peritoneum have been described. These techniques are difficult and add to the operating time, and may not be successful in closing the opening in the peritoneum. We describe a simple, effective, fast technique of repairing these tears using the bipolar diathermy. METHOD: We have used bipolar diathermy to seal inadvertent peritoneal tears occurring during TAPP/TEP repairs. This method of sealing the peritoneum has been used by us since 2015. We decided to review our results of sealing the tears in the peritoneum at TAPP/TEP from 01 Jan 2017 to 31 Dec 2019. RESULTS: A total of 152 laparoscopic inguinal hernia repair (TAPP/TEP) procedures were done by the authors from 01 January 2017 to 31 December 2019, and of these, 101 cases had some degree of peritoneal tear. All peritoneal tears were very simply sealed using bipolar diathermy. CONCLUSIONS: Peritoneal tears occurring inadvertently during Laparoscopic TAPP/TEP procedure for repair inguinal hernia can be effectively sealed with simple bipolar diathermy.

Novel interstitial deletion in Xp22.3 in a typical X-linked recessive family with Kallmann syndrome.

Kallmann syndrome (KS) is a clinically and genetically heterogeneous condition characterised by hypogonadotropic hypogonadism with anosmia or hyposmia. More than nineteen genes causing KS have been reported to date. KAL1, first identified to causing the X-linked form of KS, accounts for 10%-20% of KS patients. In this study, we designed a panel including 17 known genes causing KS for genetic diagnosis and research and report a typical and rare family of which three generations had been affected by KS. A novel CNV in Xp22.3 was identified through targeted next-sequencing technology and high-resolution microarray. The breakpoint (chrX:8536480 and chrX:8730416) was defined, and the size of deletion is about 0.24 Mb. The CNV including KAL1 and FAM9A had a negative effect on the expression of KAL1, resulting in decreased level of KAL1 mRNA in whole blood. In addition, the proband had significant improvement in testicular volumes and secondary sex characters except spermatogenesis after regular treatment, which indicates the CNV may have a negative effect on spermatogenesis. Our study expands the genotypic spectrum of KAL1 mutations associated with KS and provides a practical pipeline for genetic diagnosis or research.

The Japanese need travel vaccinations.

At a travel clinic in Kathmandu we reviewed the vaccination records from March 1997 to March 1998 for all travelers to developing countries like Nepal, for two important vaccines, namely, typhoid and hepatitis A. These travelers visited the clinic for various medical problems. One of the reasons for doing this study was that in previous years we saw a disproportionate number of Japanese travelers with hepatitis A, who had not taken the hepatitis A vaccine or immune gamma globulin for prevention of this illness. We hypothesized, therefore, that one of the reasons that Japanese patients visiting our clinic had higher rates of hepatitis A was because they were not vaccinated against this disease. There were 765 tourists for that time period out of which about 10% were Japanese. The rest were Americans, British, Israelis, Canadians, Australians, Danish and a small miscellaneous group from other countries.