Surgical management of post-traumatic transvaginal herniation of small intestine in a third-world country.

We present a case of a 26-year-old woman with a small bowel herniating from her vagina following traumatic injury from a road traffic accident. The patient was taken immediately to operating theatre for repair of her uterine defect and small bowel resection. The patient required eventual return to theatre for subtotal hysterectomy and recovered well after her surgeries. She was discharged home without any further complications and in good condition.

Strangulated gastric prolapse through a gastrostomy site requiring emergent partial gastrectomy.

Strangulated gastric prolapse through a percutaneous endoscopic gastrostomy tract is a rare and potentially life-threatening complication that requires surgical intervention. We describe a case of a 74-year-old woman who was debilitated and ventilator-dependent and who presented with acute gastric prolapse with resultant ischaemic necrosis. The patient underwent an emergent exploratory laparotomy, partial gastrectomy, repair of gastrostomy defect and placement of a gastrojejunostomy feeding tube remote to the previous location. Literature on gastric prolapse in adult patients is sparse, and therefore treatment is not standardised. In this patient with strangulated tissue, the principles of management included the assessment of gastric mucosa viability, resection of ischaemic tissue and closure of the gastrostomy defect.

Vaginal mesh kits for pelvic organ prolapse, friend or foe: a comprehensive review.

Graft use in vaginal prolapse surgery has become more common secondary to high failure rates seen with traditional repairs. Mesh has been shown to be successful when suspending the upper portion of the vagina with sacralcolpopexy and its use vaginally isi n an attempt to reproduce those results seen from the more invasive abdominal approach. A recent Cochrane review has supported its use in the anterior compartment vaginally as lower failure rates have been shown. Vaginal mesh "kits" have been developed in an attempt to make these surgeries less invasive, more standardized, and easier to perform. One of the problems that does seem to be emerging is the thought that, just because these procedures are now being produced in "kits", they can be completed by any surgeon. This may not hold true, as these are still advanced techniques that require advanced pelvic surgery skills and, therefore, it is up to surgeons to also understand this and the limitations of these procedures. The current paper reviews the history of the development of mesh kits, the techniques utilized, and the data that have been published to date on results and complications, and recommendations on how to avoid these complications. Although initial studies are encouraging, more will need to be completed prior to the recommendations of general use of these kits in all prolapse patients. We need to have further investigation on proper patient selection, we must continue research on graft composition, and we must continue to develop techniques to minimize complications of needle passage or mesh placement. Even after we gain this knowledge, it will still require advanced surgical skills to complete these types of surgeries, and to help minimize complications and maximize results.

[Modified muscle flap nephropexy in nephroptosis (experimental and clinical studies]. / K modifikatsii nefropeksii myshechnym loskutom pri nefroptoze (éksperimental'noe i klinicheskoe issledovaniia).

The proposed method consists in the creation of decapsulated anterior surface of the kidney up to the level of the upper third with the following suturing of the muscular graft taken from m. psoas major to the margins of the fibrous capsule. The method was also tested in experiment (20 dogs). The kidney was found to be fixed to the graft more rapidly and firmly when using the method proposed by the authors. In the clinic this method was used in 105 operations. The remote results (6 months-7 years) revealed only one patient with recidivation.