Laparoscopic transabdominal preperitoneal (TAPP) groin hernia repair using n-butyl-2-cyanoacrylate (LiquiBandFIX8) for mesh fixation and peritoneal closure: case report about extraperitoneal hematoma.

Introduction: A symptomatic inguinal hernia is a prevalent condition that typically requires surgical intervention. Various surgical approaches have been established for hernia repair, including several techniques for peritoneal closure and mesh fixation in laparoscopic surgery. N-butyl-2-cyanoacrylate, such as LiquiBandFIX8, offers a time-saving alternative to invasive methods for both mesh fixation and peritoneal closure. While n-butyl-2-cyanoacrylate is employed in various closure procedures, LiquiBandFIX8 is specifically designed for mesh fixation in inguinal hernia repair. Case presentation: We present a case of a 68-year old man undergoing transabdominal preperitoneal inguinal hernia repair under full heparinization. LiquiBandFIX8 was employed for mesh fixation and peritoneal closure. Upon conducting a revision laparoscopy due to a significant postoperative hematoma, we found that the mesh and peritoneum remained undamaged and fully sealed, indicating an effective fixing technique. Both the initial repair and the subsequent revision surgery were documented and the videos were subsequently analyzed. Conclusion: LiquiBandFIX8 provides a reliable adhesive strength and appropriate application for peritoneal closure and mesh fixation. When encountering extraperitoneal fluid collection, there is no anticipation of intraabdominal complications.

Perirectal intraperitoneal splenosis: A case report of MRI with laparoscopic correlation.

Splenosis is a benign acquired condition, which appears after rupture of the spleen and heterotopic auto-transplantation. Mostly found as an incidental finding on cross-sectional imaging, definitive diagnosis is frequently made histologically after resection or tissue sampling. We report a case of a 36-year-old male patient who presented with increased susceptibility to infections, chronic fatigue, and a history of traumatic splenic rupture. Cross-sectional imaging showed perirectal formations within the mesorectal fascia, and extraperitoneal splenosis was suspected. Due to the radiologically unclear entity of the masses, diagnostic laparoscopy with tissue sampling was performed. Intraoperatively the masses turned out to be intraperitoneal. Histological workup showed splenic tissue, consistent with intraperitoneal splenosis after splenic rupture. In this article we want to discuss important imaging findings and their differentials, as well as clinical implications for this rare entity.

Incidence of Dumping Syndrome after Sleeve Gastrectomy, Roux-en-Y Gastric Bypass and One-Anastomosis Gastric Bypass.

Purpose: Dumping syndrome (DS) is an important but often underreported problem occurring after bariatric surgery. It is believed that gastric bypass procedures like Roux-en-Y Gastric By-pass (RYGB) and One-Anastomosis Gastric Bypass (OAGB) are more likely to cause DS than the pylorus-preserving Sleeve Gastrectomy (SG). The aim of this study was to evaluate the incidence of DS in patients undergoing SG, RYGB and OAGB. Materials and Methods: A retrospective clinical study with 180 patients undergoing SG (n=50), RYGB (n=53) and OAGB (n=77) between 2016-2018 was performed. All clinical and demo-graphic data were assessed. The percentage of excess weight loss (%EWL) was used to evaluate weight reduction. 127/180 (70.6%) patients took part in an additional phone interview. The incidence of DS was evaluated using validated Sigstad Score. Results: Information about the occurrence of dumping symptoms and patient satisfaction was obtained from 127 patients. Median follow-up was 20.0±11.4 months. Significant differences between the surgical procedures were found for the duration of surgery, complications, weight loss, incidence of DS and satisfaction postoperatively. DS occurred in 15.6% after SG, 56.4% after RYGB and 42.9% after OAGB. A higher weight loss was observed in patients who experienced dumping symptoms. Conclusion: The present results show a clear superiority of SG regarding both perioperative results and incidence of DS compared to RYGB and OAGB and may impact clinicians and patients in their choice of procedure.

Medication overuse headache in 787 patients admitted for inpatient treatment over a period of 32 years.

BACKGROUND: Definitions of medication overuse headache have changed over time. OBJECTIVE: To evaluate the clinical characteristics of medication overuse headache patients admitted for inpatient withdrawal therapy over a period of 32 years. METHODS: We included all patients with medication overuse headache treated from 1 January 1984 to 31 December 2015. We obtained all data from the medical reports and defined three periods, P1 (1984-1993), P2 (1994-2003), and P3 (2004-2015). The p-value adjusted for multiple comparisons was set to 0.005. RESULTS: Within 32 years, a total of 787 patients accounted for 904 admissions for MOH. From P1 to P3, the proportion of patients with preexisting migraine increased from 44.3% to 53.3% (chi2 = 9.0, p = 0.01) and that with preexisting tension-type headache decreased from 47.9% to 34.6% (chi2 = 9.3, p < 0.01). The median time since onset of headache and medication overuse headache decreased from 20 to 15 years (p < 0.001) and from 3 to 2 years (p < 0.001). The median cumulative number of single doses decreased from 120 to 90 per month (p = 0.002). Overuse of triptans, non-opioid analgesics, and opioids increased, whereas overuse of ergotamines decreased over time (p < 0.001 for all tests). The use of prophylactic medication before admission increased from 8.3% to 29.9% (chi2 = 89.5, p < 0.001). CONCLUSION: This retrospective study in a large number of patients with medication overuse headache admitted for inpatient withdrawal therapy over a period of 32 years shows a trend towards changes in the preexisting headache type, a decrease in the time since onset of headache and medication overuse headache, a decrease in the number of drug doses used per month, changes in the type of drugs overused, and an increase in, but still low rate, of prophylactic medication prior to admission.

Identification of BRCA1-like triple-negative breast cancers by quantitative multiplex-ligation-dependent probe amplification (MLPA) analysis of BRCA1-associated chromosomal regions: a validation study.

BACKGROUND: Triple-negative breast cancer (TNBC) with a BRCA1-like molecular signature has been demonstrated to remarkably respond to platinum-based chemotherapy and might be suited for a future treatment with poly(ADP-ribose)polymerase (PARP) inhibitors. In order to rapidly assess this signature we have previously developed a multiplex-ligation-dependent probe amplification (MLPA)-based assay. Here we present an independent validation of this assay to confirm its important clinical impact. METHODS: One-hundred-forty-four TNBC tumor specimens were analysed by the MLPA-based "BRCA1-like" test. Classification into BRCA1-like vs. non-BRCA1-like samples was performed by our formerly established nearest shrunken centroids classifier. Data were subsequently compared with the BRCA1-mutation/methylation status of the samples. T-lymphocyte infiltration and expression of the main target of PARP inhibitors, PARP1, were assessed on a subset of samples by immunohistochemistry. Data acquisition and interpretation was performed in a blinded manner. RESULTS: In the studied TNBC cohort, 63 out of 144 (44 %) tumors were classified into the BRCA1-like category. Among these, the MLPA test correctly predicted 15 out of 18 (83 %) samples with a pathogenic BRCA1-mutation and 20 of 22 (91 %) samples exhibiting BRCA1-promoter methylation. Five false-negative samples were observed. We identified high lymphocyte infiltration as one possible basis for misclassification. However, two falsely classified BRCA1-mutated tumors were also characterized by rather non-BRCA1-associated histopathological features such as borderline ER expression. The BRCA1-like vs. non-BRCA1-like signature was specifically enriched in high-grade (G3) cancers (90 % vs. 58 %, p = 0.0004) and was also frequent in tumors with strong (3+) nuclear PARP1 expression (37 % vs. 16 %; p = 0.087). CONCLUSIONS: This validation study confirmed the good performance of the initial MLPA assay which might thus serve as a valuable tool to select patients for platinum-based chemotherapy regimens. Moreover, frequent PARP1 upregulation in BRCA1-like tumors may also point to susceptibility to treatment with PARP inhibitors. Limitations are the requirement of high tumor content and high-quality DNA.