Complications unveiled: A detailed case report on mesh migration post-incisional hernia repair.

INTRODUCTION AND IMPORTANCE: Repairing incisional abdominal wall hernia with nonabsorbable meshes is one of the most common procedures in general surgery. Mesh migration into the intestine is rare but a serious complication. It can occur months or even years after surgery and often presents with vague abdominal pain, making diagnosis tricky. CASE PRESENTATION: We report a rare case of a 52-year-old female presenting a small bowel obstruction secondary to mesh migration from the abdominal wall into the intestine, 10 years after repeated surgical repair of a ventral incisional hernia. At surgery, a mesh was migrated into a small bowl. The patient had a small bowel resection. The postoperative course was simple and the patient was discharged after 5 days. CASE DISCUSSION: Incisional hernia repair with mesh is one of the most commonly performed surgical procedures worldwide. Many complications have been linked to the use of mesh; among the most frequently reported are seromas, hematomas, and infections. Mesh migration remains an uncommon event after incisional hernia repair, and even rarer when considering complete migration within the intestinal lumen. The exact cause of this complication remains unknown. Multiple hypotheses have been proposed for mesh migration. Abdominal pain, intermittent or persistent intestinal obstruction, mass formation, and viscus perforation represent the most common clinical manifestation. Total removal of the mesh via laparoscopy or laparotomy is recommended, along with either partial or entire resection of the organ. CONCLUSION: Mesh migration is a an uncommon possible complication in case of incisional hernia mesh repair and it requires often surgical intervention.

Anesthesia management for patients with congenital epidermolysis bullosa: A challenge case report for the anesthesiologist.

INTRODUCTION AND IMPORTANCE: Congenital epidermolysis bullosa (EB) is a group of rare genetic conditions characterized by fragile skin that blisters easily. Anaesthesia management in these patients is complex due to mucocutaneous fragility, which can complicate surgical procedures and airway management. Our study aimed to report a case of successful general anaesthesia in two patients with congenital epidermolysis bullosa undergoing oesophagal dilatation. CASE PRESENTATION: The case involved a brother and sister, aged 21 and 15 respectively, both of whom have congenital epidermolysis bullosa and presented with solid dysphagia due to double stenosis of the oesophagus. Anaesthesia management included meticulous preoperative planning, use of non-adhesive monitoring equipment, careful management with video laryngoscopy, and minimisation of skin trauma. CLINICAL DISCUSSION: Both patients underwent successful esophageal dilation under general anaesthesia without perioperative complications. Airway management was achieved in the first attempt using video laryngoscopy. Analgesia was effectively treated with paracetamol and tramadol. CONCLUSION: This case illustrates the complexities and necessary precautions for anaesthesia management in patients with epidermolysis bullosa. Detailed preoperative evaluation, careful monitoring, and specific handling techniques can mitigate perioperative risks and ensure patient safety.

Simulation-based echocardiography learning contribution on training of medical residents.

INTRODUCTION: Echocardiography is a pivotal exam in critically ill patients, a specific training is crucial. Medical residents often lack echocardiography practice. AIM: This study aims to evaluate the impact of simulation-based training on medical residents' echocardiography mastery. METHODS: This interventional study was conducted among medical residents at the Simulation Center of the Faculty of Medicine in Monastir (CeSim) in January 2022. The intervention consisted of a theoretical training and a simulator-based practical training concerning echocardiography. Residents underwent evaluation before and after training through a "Pre-Test" and a "Post-Test," respectively, using a French-language questionnaire. Participation was entirely voluntary. RESULTS: A total of 28 medical residents participated in our study, with the majority being female (57.1%). The median age was 29 years (interquartile range: 28-31.75). Following training, the proportion of participants who reported having the necessary skills for echocardiography interpretation significantly increased (p<0.05). Respondents demonstrated significant improvements in their scores on theoretical tests and practical skills assessments. Concerning echocardiographic views, the percentage of participants who correctly identified the title of the parasternal small axis section increased from 53.6% before training to 100% after training (p <10-3). Significant enhancements were observed in all parameters evaluating the practice of echocardiographic sections by respondents on a mannequin after training, encompassing time to obtain the view, view quality, image quality, visualization of structures, interpretability, and image stability (p<10-3). There was a significant improvement in average response rates for echocardiographic clinical syndroms among medical residents before and after training. All participants emphasized the indispensability of ultrasound education in the training of physicians specializing in managing cardiopulmonary emergencies. CONCLUSIONS: This study reports the beneficial role of simulation-based training in enhancing the mastery of medical residents in echocardiography. Incorporating such training methods into their learning curricula is advisable.

Efficacy and safety of intraperitoneal ropivacaine in pain management following laparoscopic digestive surgery: A systematic review and meta-analysis of RCTs.

BACKGROUND: Managing postoperative pain effectively with an opioid-free regimen following laparoscopic surgery (LS) remains a significant challenge. Intraperitoneal instillation of ropivacaine has been explored for its potential to reduce acute postoperative pain, but its efficacy and safety are still under debate. This study aimed to evaluate the efficacy and safety of intraperitoneal instillation of ropivacaine for acute pain management following laparoscopic digestive surgery. METHODS: We used PRISMA 2020 and a measurement tool to assess systematic reviews 2 guidelines to conduct this review. The random-effects model was adopted using Review Manager Version 5.4 for pooled estimates. RESULTS: We retained 24 eligible RCTs involving 1705 patients (862 patients in the intraperitoneal instillation group and 843 patients in the control group). The intraperitoneal instillation group reduced total opioid consumption during the first 24 hours postoperatively (MD = -21.93 95% CI [-27.64, -16.23], P < .01), decreased pain scores at different time (4 hours, 8 hours, 12 hours and 24 hours), shorter the hospital stay (MD = -0.20 95% CI [-0.36, -0.05], P < .01), reduced the postoperative shoulder pain (MD = 0.18 95% CI [0.07, 0.44], P < .01), and decreased postoperative nausea and vomiting (MD = 0.47 95% CI [0.29, 0.77], P < .01). CONCLUSION: Intraperitoneal instillation of ropivacaine appears to be an effective component of multimodal pain management strategies following laparoscopic digestive surgery, significantly reducing opioid consumption and improving postoperative recovery markers. Despite these promising results, additional high-quality trials are needed to confirm the efficacy and safety of this approach. REGISTRATION: The registration number at PROSPERO was CRD42021279238.

Challenging diagnoses in a case report: Ovarian fibrothecoma with elevated CA125 levels mimicking malignancy.

INTRODUCTION AND IMPORTANCE: Ovarian fibromas are benign tumours arising from the connective tissue of the ovarian cortex, classified into three pathological subtypes: fibroma, thecoma, and fibrothecoma. Their diagnosis is complicated by their solid nature and potential association with ascites and pleural effusion, resembling Meigs syndrome. Elevated serum CA125 levels can further complicate differentiation from malignant ovarian epithelial tumours. CASE PRESENTATION: A 37-year-old female from a rural area presented with a distended abdomen and weight loss lasting 2 months. Clinical examinations revealed a solid pelvic mass and diagnostic tests showed significantly elevated CA125 levels. Imaging suggested a large ovarian mass and surgical intervention confirmed a fibrothecoma of the left ovary. The postoperative course was uneventful, with subsequent resolution of ascites and pleurisy. CLINICAL DISCUSSION: The diagnosis of ovarian fibromas/fibrothecomas poses challenges due to their asymptomatic nature, solid appearance, and occasional association with the Meigs syndrome. Elevated CA125 levels can mislead the diagnosis of epithelial ovarian carcinoma. The case underscores the importance of considering ovarian fibromas/fibrothecomas in the differential diagnosis of ovarian tumours with elevated CA125 levels, especially in women of reproductive age. The benign nature of these tumours necessitates a conservative surgical approach, emphasizing the importance of intraoperative frozen section analysis. CONCLUSION: Ovarian fibrothecomas associated with elevated serum CA125 levels are rare. Their presentation can mimic malignant ovarian neoplasms, leading to potential diagnostic confusion. Surgical removal remains the treatment of choice, with a favorable prognosis post-surgery.

A case report of urethral prolapse in young girls: Clinical manifestations and surgical management.

BACKGROUND AND IMPORTANCE: Urethral Prolapse (UP), first described by Solinger in 1732, is a rare condition characterized by the circular protrusion of the distal urethral mucosa through the external meatus, forming a hemorrhagic, sensitive vulvar mass. This condition is most commonly observed in prepubertal black females. This case report details the clinical manifestations and surgical management of UP in three young girls. CASES PRESENTATION: Three girls, aged 4, 5, and 6 years, were admitted with symptoms of vaginal blood spotting. Physical examinations revealed moderate bleeding and a red ring of congested, edematous tissue prolapsing through the urethral meatus. Diagnostic procedures confirmed UP, and surgical management was undertaken. The surgical approach involved the complete excision of the prolapsed tissue and mucosal-to-mucosal anastomosis under general anaesthesia. Postoperative follow-up over a mean period of 11 years showed no recurrence or urethral stricture. CLINICAL DISCUSSION: UP is a rare benign condition primarily affecting the female urethra, with several hypothesized etiologies, including weak pelvic floor structures and increased intraabdominal pressure. The typical presentation includes vaginal bleeding and a doughnut-shaped mass around the urethral meatus. Conservative management may be considered for mild cases, but surgical excision is recommended for severe cases, offering a safe and effective solution with low recurrence rates. CONCLUSIONS: UP in children, although rare, should be considered in cases of unexplained vaginal bleeding. Diagnosis is primarily clinical, and surgical resection provides a definitive and cost-effective treatment.

Laparoscopic resection of a gastric lipoma following massive upper gastrointestinal bleeding: A case report.

IMPORTANCE AND BACKGROUND: Gastric lipomas are rare submucosal tumours that account for less than 1 % of all stomach tumours. Despite their benign nature, they can lead to significant clinical manifestations such as gastric outlet obstruction and massive gastrointestinal haemorrhage. CASE PRESENTATION: We report the case of a 50-year-old woman with no prior comorbidities, presenting with severe upper gastrointestinal bleeding. Diagnostic imaging and endoscopy identified a submucosal mass in the prepyloric area, later confirmed to be a gastric lipoma. The surgical intervention involved laparoscopic resection of the mass. DISCUSSION: This case underscores the importance of considering gastric lipomas in differential diagnoses of gastrointestinal bleeding. While often asymptomatic, their potential to cause acute complications necessitates awareness among clinicians. The management strategies range from observational approaches in asymptomatic cases to surgical excision in symptomatic cases. CONCLUSIONS: Gastric lipomas, though rare and often benign, can present with life-threatening complications. Accurate diagnosis using a combination of endoscopy and imaging, particularly CT scans, is critical for effective management. Surgical removal remains the definitive treatment for symptomatic lipomas, highlighting the need for a tailored approach based on the tumour's characteristics and location.

Perineal discomfort caused by the sitting position as a rare manifestation of ectopic testicle: About two cases.

BACKGROUND AND IMPORTANCE: Perineal ectopic testis (PET) is a rare congenital anomaly; the diagnosis is typically made by conducting a physical examination of the ectopic areas and noting an empty scrotum on the corresponding side. We report two pediatric cases of PET in whom this condition was diagnosed by a discomfort induced by the sitting position. CASES PRESENTATION: Two cases of PET were operated on in our pediatric surgery department over the past three years. Patients were referred for perineal discomfort in the sitting position. Children had difficulty staying seated at home or school, this was described by parents as an abnormal fussiness after sitting. The age at diagnosis was five and three years. The diagnosis of perineal testicular ectopia was made through physical examination. Orchidopexies to the corresponding scrotum were performed in both cases via an inguinal approach. No postoperative complication was noted with a follow-up of 24 months. CLINICAL DISCUSSION: PET is typically diagnosed through clinical examination, characterized by an empty scrotum and a palpable perineal mass. The exact aetiology is unclear, but it involves abnormalities in testicular descent mechanisms, particularly the gubernaculum. PET can cause perineal discomfort when sitting, a symptom observed in the two pediatric cases presented. Early surgical intervention via orchidopexy is crucial to prevent complications. Both reported cases were successfully treated with no postoperative complications and resolution of discomfort. Prompt diagnosis and treatment are essential for preserving testicular function. CONCLUSION: Perineal discomfort on sitting was the defining diagnostic element in our cases. In practice, this symptom should be a prompt for a thorough perineal examination in children with an empty scrotum. However, the patient's age and ability to express himself determine the significance of the symptom.

Robotic versus laparoscopic total mesorectal excision with lateral lymph node dissection for advanced rectal cancer: A systematic review and meta-analysis.

INTRODUCTION: Lateral pelvic node dissection (LPND) poses significant technical challenges. Despite the advent of robotic surgery, determining the optimal minimally invasive approach remains a topic of debate. This study aimed to compare postoperative outcomes between robotic total mesorectal excision with LPND (R-LPND) and laparoscopic total mesorectal excision with LPND (L-LPND). METHODS: This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 and AMSTAR 2 (Assessing the Methodological Quality of Systematic Reviews) guidelines. Utilizing the RevMan 5.3.5 statistical package from the Cochrane Collaboration, a random-effects model was employed. RESULTS: Six eligible studies involving 652 patients (316 and 336 in the R-LPND and L-LPND groups, respectively) were retrieved. The robotic approach demonstrated favourable outcomes compared with the laparoscopic approach, manifesting in lower morbidity rates, reduced urinary complications, shorter hospital stays, and a higher number of harvested lateral pelvic lymph nodes. However, longer operative time was associated with the robotic approach. No significant differences were observed between the two groups regarding major complications, anastomotic leak, intra-abdominal infection, neurological complications, LPND time, overall recurrence, and local recurrence. CONCLUSIONS: In summary, the robotic approach is a safe and feasible alternative for Total Mesorectal Excision (TME) with LPND in advanced rectal cancer. Notably, it is associated with lower morbidity, particularly a reduction in urinary complications, a shorter hospital stay and increased number of harvested lateral pelvic nodes. The trade-off for these benefits is a longer operative time.

Challenges in the management of acute lithiasic cholangitis due to a long-retained plastic biliary stent: A case report.

BACKGROUND AND IMPORTANCE: This case report focuses on a rare cause of acute lithiasis cholangitis, which is residual choledocholithiasis on a plastic biliary stent that was placed nine years prior. CASE PRESENTATION: An 87-year-old male, with a history of hypertension and previous surgery for gallstone disease including cholecystectomy and placement of a Kehr drain in 2006, was diagnosed with residual stones in 2008 and received a plastic biliary stent after endoscopic sphincterotomy. Lost to follow-up for nine years, he presented with acute lithiasis cholangitis characterized by fever, conjunctival jaundice, leukocytosis, CRP elevation, and biochemical signs of cholestasis. CT imaging revealed choledocholithiasis on the biliary stent. The patient underwent surgical intervention, during which a dilated bile duct was discovered, a complete tangential choledocotomy was performed, and the stent/stone complex along with additional choledocholithiasis was removed. A choledochoduodenal anastomosis was subsequently performed. DISCUSSION: The use of plastic biliary stents can paradoxically lead to the formation of biliary stones, a condition termed "stentolith". Such scenarios emphasize the complications arising from prolonged stent presence, including bacterial proliferation and the consequent formation of calcium bilirubin stones. While endoscopic removal of these stent-stone complexes has been successful in a few cases, surgical intervention is often required due to the risks associated with endoscopic extraction, such as potential duodenal perforation. The choice of lithotripsy technique for endotherapy depends on availability and patient-specific factors. CONCLUSION: This complication highlights the importance of patient education, meticulous record-keeping, and regular follow-up to prevent such outcomes.

An uncommon liver abscess secondary to an ingested foreign body: A case report.

Introduction: This article discusses a case study involving a unique occurrence of a hepatic abscess caused by the presence of an ingested foreign body. Hepatic abscesses, characterized by pus accumulation within liver tissue, often result from various infections, with some cases having unidentified origins. Case presentation: This study focuses on a 75-year-old man who presented at an emergency department with persistent pain in the right upper abdomen and fever for ten days. Diagnostic tests revealed a low-density, multiloculated mass in the liver and a hyperdense linear structure near the duodenum, indicating a hepatic abscess originating from duodenal perforation due to a foreign body that had migrated from ingestion. The patient underwent antibiotic treatment and a surgical procedure involving laparotomy to extract the foreign object and drain the abscess. Conclusion: this case study underscores the rare occurrence of hepatic abscesses caused by ingested foreign bodies. Swift and accurate diagnosis, along with appropriate treatment involving foreign body removal and abscess drainage, are pivotal for favorable patient outcomes. The choice of treatment strategy impacts hospital stay duration, and understanding potential complications from foreign body ingestion enhances patient management and care.

Omentopexy versus no omentopexy in sleeve gastrectomy: an updated systematic review and meta-analysis.

Laparoscopic sleeve gastrectomy with omentopexy (O-LSG) has been compared to laparoscopic sleeve gastrectomy with no-omentopexy (NO-LSG) in terms of postoperative outcomes and one-year anthropometric results. This systematic review with meta-analysis aimed to compare the utility of omentopexy in sleeve gastrectomy. We performed a systematic review with meta-analysis according to PRISMA 2020 and AMSTAR 2 guidelines. We included studies that systematically searched electronic databases and compared the O-LSG with the NO-LSG conducted through 1st March 2023. The bibliographic research yielded 13 eligible studies. These studies included 5514 patients. The O-LSG is associated with lower leakage (OR = 0.22; 95% CI [0.08, 0.55], p = 0.001), bleeding (OR = 0.33; 95% CI [0.19, 0.57], p < 0.0001), vomiting (OR = 0.50; 95% CI [0.28, 0.89], p = 0.02), twist (OR = 0.09; 95% CI [0.02, 0.39], p = 0.001), and shorter hospital stay (MD = - 0.33; 95% CI [- 0.61, - 0.05], p = 0.02) compared with NO-LSG. The O-LSG is associated with longer operative time (MD = 8.15; 95% CI [3.65, 12.64], p = 0.0004) than the NO-LSG. There were no differences between the two groups in terms of postoperative GERD (OR = 0.53; 95% CI [0.27, 1.02], p = 0.06), readmission (OR = 0.60; 95% CI [0.27, 1.37], p = 0.23), and one-year total weight loss (MD = 2.06; 95% CI [- 1.53, 5.65], p = 0.26). In the subgroup analysis including only RCTs, postoperative GERD was lower in the O-LSG (OR = 0.26; 95% CI [0.11, 0.63], p = 0.003). Our systematic review and meta-analysis concluded that omentopexy in sleeve gastrectomy is feasible and safe It reduced leakage, bleeding, and twist. It probably increased the operative time. It may reduce vomiting, GERD, and hospital stay. We don't know if it led to an additional readmission rate or one-year total weight loss.Registration The protocol was registered in PROSPERO with the ID CRD42022336790.

Arterial embolization of focal nodular hyperplasia of the liver: A case report.

INTRODUCTION AND IMPORTANCE: Focal nodular hyperplasia (FNH) is a benign liver lesion that can pose diagnostic and management dilemmas, especially when distinguishing it from other hypervascular hepatic lesions. The benign nature of FNH often makes conservative management a priority; however, intervention may be necessary in symptomatic cases or when diagnostic uncertainty exists. CASE PRESENTATION: A 19-year-old male presenting with abdominal pain, found to have a large 25 cm FNH lesion in the right lobe of the liver. Initial diagnosis was achieved through ultrasonography and contrast-enhanced computed tomography (CECT), with histopathological confirmation via core needle biopsy. Given the lesion's size and the patient's symptomatic presentation, we opted for arterial embolization, a less invasive surgical approach, over traditional resection methods. This technique not only led to symptom resolution but also resulted in a significant reduction in lesion size. CLINICAL DISCUSSION: Our approach to managing this FNH case involved a multidisciplinary team. The decision to employ arterial embolization over more invasive surgical options was based on the lesion's characteristics, the patient's age, and the potential for significant morbidity associated with traditional surgery. Arterial embolization of the FNH lesion resulted in complete resolution of symptoms and a significant reduction in lesion size, from 25 cm to 12 cm, demonstrating the effectiveness of this technique in managing large FNH lesions. CONCLUSION: Our findings contribute to the scientific literature by showcasing the potential of less invasive surgical techniques in the management of FNH, offering valuable insights for clinicians faced with similar diagnostic and therapeutic challenges.

A case report of primary pancreatic lymphoma revealed by an acute pancreatitis.

INTRODUCTION: Primary pancreatic lymphoma (PPL) is a rare malignancy. Diffuse large B-cell lymphoma is the predominant subtype, often affecting the pancreatic head in elderly males. Due to its rarity and nonspecific symptoms, PPL is frequently misdiagnosed, leading to unnecessary surgeries. This case report discusses the diagnosis and management of PPL in a 47-year-old female, emphasizing the challenges in its identification. CASE PRESENTATION: A 47-year-old female with no medical history presented with severe epigastric pain and jaundice. Diagnosed initially as acute pancreatitis. The abdominal CT scan showed a tumor in the head of the pancreas suggesting pancreatic adenocarcinoma invading the vessels, making it minimally borderline. However, due to the presence of large intra- and retroperitoneal lymph nodes casting doubt on the diagnosis, we further investigated with an MRI and Endoscopic Ultrasound with fine-needle aspiration, which ruled out adenocarcinoma and confirmed a pancreatic diffuse large B-cell lymphoma. The patient underwent chemotherapy with CHOP, showing significant improvement after six cycles. DISCUSSION: Primitive pancreatic lymphoma (PPL) is a rare form of non-Hodgkin lymphoma, often mimicking other pancreatic diseases. B-cell lymphomas, especially diffuse large B-cell lymphoma (DLBCL), are common in PPL. Diagnostic criteria include the bulk of disease in the pancreas, no splenic or hepatic involvement, and normal white blood cell count. Imaging modalities aid in diagnosis, but histopathological evaluation is essential. Treatment options include chemotherapy, radiation therapy, and surgery, with rituximab-based regimens being common for DLBCL. CONCLUSIONS: B-cell pancreatic lymphoma poses diagnostic challenges due to nonspecific symptoms. A definitive diagnosis requires histopathological evidence, often obtained through minimally invasive procedures like endosonography-guided biopsy. Treatment involves chemotherapy, immunotherapy, and radiation, with early detection correlating with improved outcomes. Surgery's role is limited due to the diffuse nature of the disease. This case underscores the importance of considering PPL in the differential diagnosis of pancreatic masses, especially in atypical clinical presentations.

Primary isolated hydatid cyst of the spleen: A case report.

INTRODUCTION AND IMPORTANCE: Primary (isolated) splenic hydatid cyst is rare and accounts for less than 2 % of hydatid patients, even in endemic regions. Diagnosis of splenic hydatid cyst can be challenging due to the rarity of the condition and its nonspecific symptoms. Surgery is the mainstay of treatment. This case report discusses management options for such a rare condition. CASE PRESENTATION: We present a 33-year-old female patient with abdominal pain for six months and splenomegaly. Ultrasonography and CT scan showed a giant splenic cyst with clear walls and multi-vesicular contents suggestive of a hydatid cyst. There was no involvement of the liver or other organs. Indirect hemagglutination was positive for Echinococcus. Through a left subcostal incision total splenectomy was performed. The patient was discharged from hospital on the sixth postoperative day. No local recurrence was detected during postoperative follow up. CASE DISCUSSION: Primary splenic hydatid disease is rare. It may be detected incidentally or present with nonspecific complaints. If untreated, a splenic hydatid cyst can lead to various potentially severe complications, including cyst rupture and secondary infection. Standard treatment is open total or partial splenectomy: preservation surgery should always be considered, to avoid post splenectomy infection, especially in young patients. CONCLUSION: Primary splenic hydatid cyst is rare even in endemic areas. Symptoms may be non-specific. Standard treatment is open total or partial splenectomy.

Severe Hypernatremia During Hydatid Cyst Surgery: An Anusual Cause Of Acute Abdomen.

Treatment of liver hydatid cysts is still in most cases surgical. To avoid the recurrence of hydatid cysts injection of scolicidal products inside the cystic cavity is an important step in the surgical procedure. Many scolicidal solutions are used. Hypertonic Saline Solution (HSS) is widely used by surgeons; however, there is a risk of hypertonic saline resorption and acute hypernatremia. Iatrogenic hypernatremia can be life-threatening. We report three cases of hypernatremia secondary to HSS injection for hydatid cyst disease treatment. The objective of this study was to discuss the clinical features, and treatment of this rare complication.

Stapled Anastomosis Versus Hand-Sewn Anastomosis With Mucosectomy for Ileal Pouch-Anal Anastomosis: A Systematic Review and Meta-analysis of Postoperative Outcomes, Functional Outcomes, and Oncological Safety.

PURPOSE: This systematic review and meta-analysis aimed to compare outcomes between stapled ileal pouch-anal anastomosis (IPAA) and hand-sewn IPAA with mucosectomy in cases of ulcerative colitis and familial adenomatous polyposis. METHODS: This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines 2020 and AMSTAR 2 (Assessing the methodological quality of systematic reviews) guidelines. We included randomized clinical trials (RCTs) and controlled clinical trials (CCTs). Subgroup analysis was performed according to the indication for surgery. RESULTS: The bibliographic research yielded 31 trials: 3 RCTs, 5 prospective clinical trials, and 24 CCTs including 8872 patients: 4871 patients in the stapled group and 4038 in the hand-sewn group. Regarding postoperative outcomes, the stapled group had a lower rate of anastomotic stricture, small bowel obstruction, and ileal pouch failure. There were no differences between the 2 groups in terms of operative time, anastomotic leak, pelvic sepsis, pouchitis, or hospital stay. For functional outcomes, the stapled group was associated with greater outcomes in terms of seepage per day and by night, pad use, night incontinence, resting pressure, and squeeze pressure. There were no differences in stool Frequency per 24h, stool frequency at night, antidiarrheal medication, sexual impotence, or length of the high-pressure zone. There was no difference between the 2 groups in terms of dysplasia and neoplasia. CONCLUSIONS: Compared to hand-sewn anastomosis, stapled ileoanal anastomosis leads to a large reduction in anastomotic stricture, small bowel obstruction, ileal pouch failure, seepage by day and night, pad use, and night incontinence. This may ensure a higher resting pressure and squeeze pressure in manometry evaluation. PROTOCOL REGISTRATION: The protocol was registered at PROSPERO under CRD 42022379880.

A case report of a large Splenic epidermoid cyst treated with partial splenectomy.

Introduction and importance: Splenic epidermoid cysts are rare primary congenital cysts composed of an epithelial lining that represent a small proportion of nonparasitic splenic cysts. Despite their infrequency, there is a lack of uniform diagnostic and treatment guidelines for these cysts, emphasizing the need for further research and standardized reporting. Case presentation: A 45-year-old female presented with left upper quadrant abdominal pain, characterized by a pressing sensation. Physical examination revealed a palpable mass in the upper left quadrant. Laboratory test results were normal. Abdominal ultrasonography and CT tomography confirmed a large splenic unilocular cyst consistent with an epidermoid cyst. Surgical intervention involved aspiration of the cystic fluid, partial splenectomy, and pathological examination. The patient's postoperative recovery was uneventful. Clinical discussion: The origin of splenic epidermoid cysts remains unclear, with theories suggesting entrapment of mesothelial cells during embryonic development. The clinical presentation varies with cyst size, often causing abdominal pain and a palpable mass. Diagnostic modalities include ultrasonography and CT scans. Surgical intervention is recommended for symptomatic or suspicious cysts to prevent complications. The chosen approach depends on cyst characteristics and patient factors. This case highlights the challenges and considerations in managing splenic epidermoid the cysts and emphasizes the need for individualized treatment approaches. Conclusion: This case contributes to the understanding of splenic epidermoid cysts and demonstrates a successful subtotal splenectomy as a treatment approach. Further research and standardized guidelines are essential to improve the management of these rare lesions and to provide better insights into their etiology and optimal treatment strategies.

Cornual pregnancy as a rare entity of ectopic pregnancy: A case report.

INTRODUCTION AND IMPORTANCE: Cornual pregnancy, an infrequently reported form of ectopic pregnancy occurring in the uterine horn, is inadequately documented in medical literature, with an incidence below 2 %. This condition poses a substantial risk to maternal health due to delayed diagnosis and the potential for life-threatening bleeding after rupture. CASE PRESENTATION: We present a case report following the SCARE guidelines that details a 32-year-old woman with abdominal pain and abnormal uterine bleeding. Clinical examination, ß-HCG levels, and endovaginal ultrasound confirmed the presence of a 4 cm unruptured right cornual pregnancy. The patient underwent a minilaparotomy, which revealed the ectopic pregnancy, followed by a successful cornuostomy and right salpingectomy. Postoperative recovery was uneventful. CLINICAL DISCUSSION: Cornual pregnancy, comprising around 2 % of ectopic pregnancies, is associated with increased risks of rupture and maternal morbidity. Major risk factors include a history of pregnancy termination, miscarriage, STIs, and smoking. Diagnosis is often delayed, leading to an increased risk of bleeding. Pelvic pain is a common presenting symptom, and sonographic findings aid in accurate diagnosis. CONCLUSION: Cornual pregnancy, though rare, represents a serious condition with a significant risk of maternal morbidity and mortality. A timely diagnosis is crucial for effective treatment, with ultrasound playing a pivotal role, complemented by the essential contribution of laparoscopy. This case underscores the importance of prompt intervention to mitigate the associated risks and improve patient outcomes.