Total cysto-pericystectomy for huge echinococcal cyst located on hepatic segment IVb. Case report and review of the literature.

Hepatic hydatid disease is located mainly in the right liver. It is usually solitary and asymptomatic; however, a large cyst may cause compression symptoms. We report a case of a huge echinococcal cyst located in segment IVb of the liver in a 39-year-old female, 17 x 11 cm in dimensions, causing persistent epigastric pain and discomfort. The diagnosis was made by a computed tomography (CT) scan, which showed the cystic mass with the characteristic daughter cysts and reactive caps (pericystic wall) consisting of fibrous connective tissue and calcifications. The patient underwent radical resection by total cysto-pericystectomy and had an uneventful postoperative course. Follow-up showed no recurrence in CT and normal liver function test. Total cysto-pericystectomy, as an alternative to hepatectomy, is the preferable choice of radical resection operation, nowadays, in the management of liver hydatid disease even in huge cysts.

Current management of diverticular disease complications.

Diverticular disease is a common problem in the western population and sometimes leads to serious complications such as hemorrhage, bowel stenosis, obstruction, abscesses, fistulae, bowel perforation, and peritonitis. The severity of these complications can differ, and it is not always clear which procedure is indicated in each case and what measures should be followed before bringing the patient into the operating room. Certain operations have high rates of morbidity and mortality, especially in compromised patients. Along with advancements in imaging and minimally invasive techniques, the indications for surgery have currently being adapted to "damage limitation" or "down-staging" protocols, which seem to offer improved results. There are still some questions to be solved in the following years by prospective studies, such as the usefulness of laparoscopic lavage in purulent peritonitis or of Hartmann's procedure in fecal peritonitis. These indications, based on current literature, are systematically discussed in the present review.

Intraperitoneal administration of bevacizumab intraoperatively does not affect abdominal wound healing in rats.

BACKGROUND: Bevacizumab is a monoclonal antibody targeted at vascular endothelial growth factor (VEGF) to treat advanced colorectal cancer as well as other malignancies, but the ideal time point for its administration in patients scheduled for surgery is not well defined due to serious concerns regarding possible side effects on wound healing. Therefore, we conducted an experimental study in rats to clarify this issue. METHODS: Four groups of 10 Wistar rats each underwent a 4-cm midline laparotomy and closure of the wound in 2 layers. In the treatment groups (A and B), bevacizumab (Avastin(®)) received a single dose of 5 mg/kg i.p., and an equal amount of saline was given to the control groups (C and D). Groups A and C were sacrificed on the 7th postoperative day, and groups B and D on the 14th postoperative day. Wounds were inspected by two independent observers upon sacrifice and results were recorded; wound tissues were sent for histology to assess the degree of fibrosis and measurement of tissue hydroxyproline levels. Serum levels of endothelin-1, C-reactive protein, pro-oxidant/antioxidant balance and carbonylated proteins were also determined. For statistical analysis, the Mann-Whitney U test was used. RESULTS: Wound healing did not differ among groups both on the 7th and the 14th postoperative days, and there was also no significant difference regarding the degree of inflammation, fibroblast proliferation and collagen synthesis, as well as hydroxyproline and biochemical marker levels among the groups. CONCLUSIONS: Intraperitoneal bevacizumab administered intraoperatively does not significantly affect abdominal wound healing in rats.

Tension-free by mesh-plug technique for inguinal hernia repair in elderly patients.

BACKGROUND: elderly patients are steadily becoming a growing part of the population. The aim of this study is to evaluate the outcome of open inguinal hernia repair in patients aged over 65 years. METHODS: from January 1999 to December 2008, a total of 719 patients underwent open tension-free inguinal hernia repair with mesh-plug; 301 among them were ≥ 65 years old. RESULTS: elderly patients had a mean age of 72.4 years (women 3.3%), while the mean age of younger patients was 48.7 years (women 5.7%). According to the ASA score, patients aged ≥ 65 years were at significantly higher risk than the younger patients. Spinal anesthesia was used most frequently in both groups. No significant differences were found in postoperative pain, mortality and recurrence. Morbidity and hospital stay were significantly higher in patients aged ≥ 65 years. CONCLUSIONS: open hernia repair in the elderly is safe and well tolerated, but it is associated with higher morbidity and longer hospitalization.

Current management of diverticular disease of the colon.

The medical treatment plays the first role in the vast majority of cases. Severe acute diverticulitis requires hospitalization and supporting care with intravenous fluids and antibiotics such as ciprofloxacin and metronidazole. Emergency operative intervention is necessary if complication occurs. Laparoscopic surgery has a well-defined place and such colectomy has been gaining, nowadays, more popularity.

Retractile mesenteritis appearing as a sigmoid colon tumor.

Retractile mesenteritis is a rare, fibrosing, inflammatory disease affecting the adipose tissue of the intestinal and colonic mesentery. So far, about 300 cases have been reported in the literature. We present a case of retractile mesenteritis.