Laparoscopic plication of the linea alba as a repair for diastasis recti - a mesh free approach.

Distasis recti is a common occurrence in multiparous women (1), caused by repeated stretching of the abdominal wall by the gravid uterus. A small proportion of patients have a persisting weakness which may be symptomatic and present to the surgeon. We would like to present a case which, thus far, has had a successful outcome from laparoscopic plication of the linea alba without mesh. The benefits of this approach are as for any laparoscopic versus open technique, most notably improved recovery time, reduced pain and wound infection. Furthermore, avoidance of a mesh negates the risks associated with insertion of a foreign body.

Pancreatic carcinoma: report of two cases presenting with unusual metastases.

We report two patients with adenocarcinoma of the body and tail of the pancreas who presented with features localized to the metastatic sites. A 67-year-old gentleman presented with right groin mass due to spermatic cord metastasis and later developed duodenal obstruction; the other gentleman was 69 years old and presented with change of bowel habit as a result of pelvic/pararectal metastasis.

Laparoscopic transperitoneal adrenalectomy.

BACKGROUND: From November 1993 to May 2002 a total of 172 laparoscopic adrenalectomies were attempted in 152 patients in centers throughout the United Kingdom. RESULTS: The median age was 52 years (18-77 years). Sixty-three percent were female. Indications for resection were Conn's syndrome (60), pheochromocytoma (35), Cushing's disease (24), Cushing's adenoma (8), cortisol-secreting carcinoma (1), other secreting tumor (2), nonfunctioning adenoma (17), congenital adrenal hyperplasia (4), metastatic disease (7), nonsecreting adrenal carcinoma (2), others (12). Median size of the lesions was 3.0 cm (0.5-20 cm). Median operating time was 65 min (30-170 min). Conversion to an open procedure was necessary in 10 patients (7%). Minor morbidity occurred in nine patients (5%). Major morbidity occurred in two patients (pancreatitis, peritonitis). Median hospital stay was 3 days (1-16 days). At median follow-up of 36 months (1-105 months) five patients (4%) had persistent hypertension. No patient had evidence of recurrent hormonal excess. CONCLUSIONS: Laparoscopic removal of the adrenal gland should be considered the surgical procedure of choice in experienced minimally invasive centers.

Large bowel ischemia following laparoscopic inguinal hernioplasty.

The adverse physiological effects of pneumoperitoneum are well understood. However, the clinical implications of compromised mesenteric circulation through several mechanical and physiological mechanisms are not as well recognized. We describe a fatal case of large bowel ischemia following an elective laparoscopic transperitoneal inguinal hernioplasty. The patient was a 78-year-old man who died within 30 h after an uneventful anesthesia and laparoscopic surgery. An autopsy revealed thrombosis of the inferior mesenteric artery and an infrarenal aortic aneurysm with thrombotic plaque on its wall. We reviewed the relevant literature on laparoscopic procedures and mesenteric ischemia. To our knowledge, this is the first reported case of large bowel ischemia following pneumoperitoneum. We conclude that the presence of an aortic aneurysm is an added risk factor in laparoscopy.

"The stones...to rise".

Late complications of laparoscopic cholecystectomy are less addressed. Spillage of stone during laparoscopic cholecystectomy is a recognized complication. However, late sequelae of spillage of stones are less clear. We report a case of late and recurrent subphrenic abscess following laparoscopic cholecystectomy. This was a 65-year-old gentleman who underwent laparoscopic cholecystectomy in 1991. He presented 3 years and even 10 years after the operation with subphrenic abscess. Interesting CT scan findings are described. Surgical open drainage is recommended as opposed to percutaneous drainage. Emphasis is given to take precautions to avoid spillage of stones. We feel that this is the first case of a complication of laparoscopic cholecystectomy presenting so late and as a recurrent problem.

Intestinal pseudoobstruction in acute Lyme disease: a case report.

We report here a case of acute Lyme disease in a 61-yr-old man who developed a facial nerve paralysis and a relentless intestinal pseudoobstruction 2 wk after the initial prodrome. Both the facial nerve paralysis and pseudoobstruction persisted for a month until the patient sought medical attention. Both lesions resolved only after treatment for Lyme disease was initiated. The temporal association of the pseudoobstruction with the somatic cranial neuropathy and the response of both to specific therapy for Lyme disease suggest that the former was likely the result of a reversible autonomic neuropathy or dysfunction.

Oxides, onions, and other matters gastrointestinal--1996--a perspective.

A selection of landmark articles for a given year in any subject risks being somewhat subjective, and subjectivity is best avoided in scientific endeavor. However, the very nature of such a selection process invites judgment. Like most judges, I, too, claim to avoid conscious bias, but no one who has ever graced the bench can claim that at the subconscious level personal bias has never crept into a decision. Similarly, deep down in the vault of my subconscious, I love a maverick. That perhaps explains why so many articles that challenge long-held beliefs have especially found favor. Among them are those that question the strength of the association of Helicobacter pylori with gastric cancer, the usefulness of surveillance endoscopy in patients with Barrett's esophagus, a randomized trial that casts doubt on the preeminence of laparoscopic cholecystectomy, and a metaanalysis that concludes that corticosteroids may not be nearly as good for alcoholic hepatitis as we were once told. I have tried to resist the temptation to be too laudatory of technologic advancement, unless the benefit to the patient of such technology has been defined clearly. Thus, of all of the new technologies (endoscopic retrograde choledochopancreatography is no longer a new technology), only endoscopic ultrasonography finds a place. Articles that assess preventive strategies and are in the realm of epidemiology have received mention. All in all, 1996 was not a spectacular year for major therapeutic advances. In contrast, some notable advances have been made in the laboratory, and perhaps the most important has to do with the role of nitric oxide both in the regulation of normal function and in the genesis of disease.