[Expert opinion on the basic surgical technique for laparoscopic ventral hernia repair]. / Técnica quirúrgica básica consensuada para el tratamiento por vía laparoscópica de las hernias ventrales.

Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.

Inhibitory effect of calcium on carcinogenesis at the site of colonic anastomosis: an experimental study.

PURPOSE: A study was made to assess the effect of oral calcium supplementation on colorectal carcinogenesis at the colocolic suture line and in the rest of the colon following administration of a carcinogen. METHODS: Fifty-nine rats were randomly divided into two groups: control (given a standard diet for rats and mice containing 0.8 percent calcium) and treatment (given the same diet as before but with 2 percent calcium). Carcinogenesis was induced by 26 weekly injections of 1,2-dimethylhydrazine. All animals were subjected to an end-to-end colonic anastomosis at the beginning of the experiment using five stitches of steel wire. RESULTS: The control group developed significantly more tumors per animal at both the anastomosis (P < 0.001) and in the rest of the colon (P < 0.001). In addition, the percentage of rats with tumors was significantly higher in the control group at both the anastomosis (chi-squared = 12; df = 1, P < 0.001) and in the rest of the colon (chi-squared = 7.12; df = 1, P < 0.01). The mean surface of tumors was likewise greater in the control group at the anastomosis (P < 0.001) and throughout the rest of the colon (P < 0.001). Finally, there were significantly more small-bowel tumors (excluding the duodenum) in the control group (P < 0.05). CONCLUSIONS: It is concluded that calcium supplementation decreases the tumor yield at the site of end-to-end colonic anastomosis and in the rest of the colon and small bowel (excluding the duodenum).

[Colorectal tuberculosis]. / Tuberculosis colorrectal.

Intestinal tuberculosis has been a clinical rarity in the western world since the tuberculostatic agents were discovered. The most common location of these lesions is usually the ileocecal region, lesions of the transverse colon being much less frequent and perforation of this viscus being exceptional. The etiological diagnosis is usually difficult because there are no specific radiological signs and false negatives are often found in biopsy material obtained by colonoscopy since the process is mainly submucous. This disease is often diagnosed during operation so treatment is usually resection. Should a preoperative diagnosis be made, the picture generally responds to tuberculostatics.