De Garengeot's hernia: a comprehensive review.

PURPOSE: Acute appendicitis within a femoral hernia is a rare condition that was first described by Rene Jacques de Garengeot. In the present study, we summarize the existing evidence on de Garengeot's hernia, with special emphasis on its clinical presentation and diagnostic approach. METHODS: A thorough search of the English-language literature published between 1980 and 2011 was performed. Studies reporting cases of de Garengeot's hernia were selected using specific inclusion criteria (description of femoral hernia appendicitis, statement of patient demographics and symptoms, and statement of diagnostic tests performed). RESULTS: Thirty-one studies that encompassed 36 patients (28 women, mean age 71.5 years) with de Garengeot's hernia were included in our analysis. Patients presented with a right groin mass in 35 (97 %) cases. The mass was almost always painful (n = 35, 97 %), while 14 (39 %) of the patients were febrile. Mean duration of symptoms was 5.17 days. Fifty-six percent of the groin masses were erythematous. Leukocytosis was present in 67 % of the patients, and 25 patients underwent imaging investigation with X-ray (n = 11), Ultrasound (n = 5) or Computed Tomography (CT, n = 9). Twenty percent of the Ultrasound and 44 % of the CT studies were diagnostic, leading to an overall rate of 14 % of femoral hernia appendicitis preoperative diagnosis. Eighty-one percent of the patients underwent herniorrhaphy with sutures while a mesh was used in 19 %. Mean hospital stay was 6.23 days. CONCLUSION: Preoperative diagnosis of de Garengeot's hernia is difficult due to its atypical clinical presentation. Further surgical treatment depends on the surgeon's sound clinical judgment.

Changes in treatment of rectal cancer: increased use of low anterior resection.

PURPOSE: The most common surgical procedures for patients with rectal cancer are low anterior resection (LAR) or abdominoperineal excision (APE). The aim of the present study is to evaluate and report the changes in the incidence of LAR and APE in the surgical treatment of rectal cancer over the last 15 years in a single surgical department. METHODS: The patient sample consisted of 251 consecutive patients (mean age 65.17; age range 22-87) that underwent surgical treatment for rectal cancer in a single center from 1996 to 2010. This time frame was divided into three 5-year periods (1996-2000, 2001-2005 and 2006-2010). Patients were classified into one of the aforementioned groups, depending on the date of their treatment. RESULTS: In the first period (1996-2000), 71 patients were treated for rectal cancer. Among them, 32.4% (n = 23) underwent an abdominoperineal excision (APE) while 56.3% (n = 40) were treated with LAR. In the second period (2001-2005), included 102 patients, from which 29.4% (n = 30) received an APE and 60.8% (n = 62) underwent a LAR for their disease. In the final period (2006-2010), from the 78 patients, only 12.8% (n = 10) of them underwent APE, while 74.3% (n = 58) were treated with LAR. There was a statistically significant (chi-square test, P = 0.005) difference between the 3 periods of time concerning the performance of LAR and APE. CONCLUSIONS: According to the results of the present study, the rates of APE seem to decrease during the last 15 years, while LAR is more widely used in the surgical treatment of rectal cancer.

Early and late complications of stapled haemorrhoidopexy: a 6-year experience from a single surgical clinic.

PURPOSE: Introduction of stapled hemorrhoidopexy (SH) brought a radical change in the treatment of haemorrhoidal disease. The aim of this study is to evaluate the results and the complications (early and late) from the use of this technique. METHODS: During the last 6 years (2005-2011), 123 patients underwent a SH in our ward. Our sample consists of 79 male and 44 female patients with an average age of 48.2 years (range 22-83 years). Of them, 83 had third-degree haemorrhoidal disease, 34 had fourth-degree and 6 had second-degree bleeding haemorrhoids. The follow-up period was 6-72 months. RESULTS: Pain was minimal or even not existent. Additional sutures or use of adrenaline 1:200.000 for haemostasis were required in 6 patients (4.8%). The bleeding has been diminished with the use of this new haemorrhoidectomy stapler PPH03. Urinary retention, which was observed in 3 patients (2.4%), was temporary and the use of catheter was not needed. As a late complication, 'faecal urgency' occurred in 8 patients (6.5%), and disappeared after some months. No recurrent haemorrhoidal disease occurred. No cases of chronic pain were reported. Average hospital stay was 1 day, except for 2 patients who remained for 2 days for bleeding observation. CONCLUSIONS: The correct application of SH reduces the possible complications. The advantages of the stapled procedure are reduced postoperative pain, the minimal hospital stay and early return to work.