Latif's point: A new point for Veress needle insertion for pneumoperitoneum in difficult laparoscopy.

INTRODUCTION: Creating pneumoperitoneum is the most challenging step during laparoscopy. The periumbilical area is the classic site for Veress needle insertion. We adopted a new access point for peritoneal insufflation. METHODS: We introduced a new point for Veress needle insertion to create pneumoperitoneum during difficult laparoscopic procedures. The needle is placed between the xiphoid process and the right costal margin, and it then proceeds toward the patient's right axilla. We collected data to compare using this new method of peritoneal insufflation with using Palmer's point for pneumoperitoneum. RESULTS: Since 2013, we have used this new technique in 570 patients (first group) and Palmer's point in 459 patients (second group). Among these patients, 196 patients (20%) had had previous abdominal operations, 98 patients (10%) had irreducible ventral hernia, and 735 patients (70%) were morbidly obese. The two groups were comparable in terms of patient characteristics. The mean time to create pneumoperitoneum in the first group was 0.8 ± 0.002 min compared to 1.08 ± 0.007 min in the second group (P ≤ 0.5). The mean number of punctures was 1.57 ± 1.02 in the first group compared to 2.9 ± 1.5 in the second group (P≤ 0.5); in the first group, 97% were successful on the first attempt entry, whereas this figure was 91% in second group. In the first group, the liver was punctured in 13 patients without any further complications; no other viscera were punctured. In the second group, gastric puncture occurred in 5 cases, transverse colon in 2 cases, and omental injury in 12 cases. CONCLUSION: This new access point may represent a safe, fast, and easy way to create pneumoperitoneum, as well as a promising alternative to Palmer's point in patients who are not candidates for classic midline entry.

Feasibility of mesh repair for strangulated abdominal wall hernias.

BACKGROUND: Prosthetic mesh reduces the risk of hernia recurrence. The use of mesh in patients with strangulated hernias requiring bowel resection is controversial. PATIENTS AND METHODS: Patients with acutely incarcerated hernias (with small intestine contents) who underwent polypropylene mesh hernioplasty were included in this prospective study from June 2005 to Jan. 2011. RESULTS: 163 patients were included; 48 required intestinal resection and anastomosis (Group I) and 115 did not (Group II). Operative times and hospital stay were longer in Group I (P = 0.001). No significant difference was noted between both groups in terms of postoperative morbidities (16.6% vs 13% P = 0.5), wound infection (6% vs 4% P = 0.6), and recurrence rate (2% vs 2.8% P = 0.8), All cases of wound infection were successfully managed with drainage and local wound care and no mesh had to be removed. One patient in Group I and five patients in Group II died of concomitant diseases in the follow-up period (P = 0.5). CONCLUSION: Mesh hernioplasty is crucial to prevent recurrence, and it is safe to utilize it in repair of acutely incarcerated hernias even if associated with intestinal resection.

Case report: conservative treatment of liver injury during percutaneous nephrolithotomy.

Liver injury during percutaneous nephrolithotomy (PCNL) is very rare and is usually overlooked. In this report, we present a case of inadvertent liver injury during right supracostal PCNL and describe diagnostic tools, conservative management measures, and outcome. A literature review of potential risk factors and suggested techniques to avoid injuring the liver during PCNL is also presented.