Lichtenstein tension-free repair of inguinal hernia.

Recurrences have been a significant problem following hernia repair. The purpose of this study was to present our experience of Lichtenstein tension-free repair of inguinal hernia. In this retrospective study, 223 inguinal hernia repairs were performed between September 2000 and August 2003 in 203 patients, using a polypropylene mesh. The main outcome measure was early and late complications and especially recurrences. There were 189 males (93.1%) and 14 females (6.9%). Inguinal hernia was indirect in 70% of cases (n=156), direct in 25% (n=56), and of the mixed type in 5% (n=11). Bilateral inguinal hernia was found in 20 patients (9.8%). 210 (94.2%) of hernias were de novo, while 13 (5.8%) were recurrences. The mean patients age was 54.3 years (range, 32-71 years). The follow-up was completed in 160 patients (78.8%) by clinical examination. The median follow-up period was 3.0 years (range, 1-5 years). Seroma and postoperative neuralgia were observed in one and 5 patients respectively. There was only one recurrence (0.4%) four years later. Lichtenstein tension-free mesh repair of inguinal hernia is a simple and safe method, with no significant early and late morbidity and achieved a method with no recurrence during the follow-up period.

Bleeding from the upper gastrointestinal tract after Mason's vertical banded gastroplasty.

BACKGROUND: Gastric bleeding is a rare complication after a vertical banded gastroplasty (VBG). Only a few cases of gastric bleeding after a VBG have been reported, and there is discussion about its etiology. We present two cases of gastric bleeding after a VBG, and discuss the etiology, diagnostic approach and management. METHODS: During the period 1989-98, we treated two cases of gastric bleeding out of 328 morbidly obese patients that underwent a VBG. The first patient was a 36-year-old woman with body mass index (BMI) 61.5. Gastric bleeding occurred on the 7th postoperative day, due possibly to the increased dose of Low Weight Molecular Heparin (LWMH) which was administrated as prophylactic anticoagulation. The second case concerns a 27-year-old man with 54.0 BMI. Gastric bleeding occurred on the 16th postoperative day and was attributed to a stress ulcer. RESULTS: Both patients were treated conservatively successfully. In the first patient, bleeding was stopped when LWMH was discontinued. In the second patient, bleeding was stopped by gastroscopic epinephrine injection in the bleeding spot. CONCLUSIONS: From our cases and review of the literature, gastric bleeding after a VBG is rare, may be treated easily with conservative measures. Tension of the mesh that surrounds the canal between the two compartments, gastric mucosal irritation from the nasogastric tube and postoperative stress ulcer formation are the most frequent causes of this complication.

Ulcerative colitis and acute stroke: two rare complications after Mason's vertical banded gastroplasty for treatment of morbid obesity.

The authors present a very rare case of ulcerative colitis and acute stroke appearing as complications after Mason's vertical banded gastroplasty for treatment of morbid obesity in a 46-year-old man. On the basis of recent studies, the authors attempt to find the correlation of these three diseases and the possible effect of each disease on the appearance of the others. The dilemmas in the treatment of this patient are also described.

Localisation and surgical treatment of insulinomas.

Most insulinomas are solitary, benign and functional neuroendocrine pancreatic tumours which give rise to manifold symptoms. Their preoperative localisation is often unclear, but the cure rate after their excision is very high. It was the aim of this study to analyse and evaluate our group of patients with regard to preoperative tumour localisation and overall surgical results. Twelve patients with a biochemical diagnosis of organic hyperinsulinism were surgically treated. Diagnosis was made with the combination of magnetic resonance imaging, computed tomography, selective angiography and intraoperative portal vein sampling. In five patients, the tumour was enucleated, in three patients Whipple procedure was performed; while three patients underwent left pancreatectomy with spleen preserving in two cases. The twelfth patient underwent total pancreatectomy following Whipple procedure performed elsewhere. There was no postoperative death. The complications were two pancreatic fistulas and two wound infections. The fasting pre- and postoperative plasma glucose mean value was 2.8 mm/l and 4.9 mm/l, respectively; while the pre- and postoperative plasma insulin mean value was 282 pm/l and 72 pm/l, respectively. Accurate diagnosis, preoperative localisation and diligent surgical exploration by experienced surgeons are the key to a successful outcome in patients with insulinomas.