Preoperative treatment with botulinum toxin A: a tool for giant groin hernia repair? Case report.

<b>Introduction:</b> Giant groin hernia is an unusual disease nowadays and its management can be a challenge for surgeons. The application of botulinum toxin A as a preoperative therapy could decrease the thickness of the lateral wall muscles, increase their length and increase the volume of the abdominal cavity facilitating the surgical repair. Morbidity and mortality due to high intra-abdominal pressure would decrease, allowing a minimal tension closure after reduction of the herniated viscera. <br><b>Case report:</b> We present the repair of two cases of massive inguinal hernia with loss of domain using preoperative abdominal wall injection of botulinum toxin.

Safety and feasibility of cholecystectomy in octogenarians. Analysis of a single center series of 316 patients.

INTRODUCTION: Cholecystectomy is the treatment of choice for symptomatic cholelithiasis. However, outcomes for patients over 80years of age are not well studied. The primary aim of this study was to describe the safety and feasibility of cholecystectomy, including in the acute setting, in a cohort of patients≥80 years of age. MATERIAL AND METHODS: A retrospective study of patients aged≥80 years submitted to cholecystectomy at a single institution from January 2013 to January 2018 was performed. Severity of acute cholecystitis was graded according to the updated Tokyo Guidelines 18. Early cholecystectomy was defined as being performed within the first 48h after admission and delayed when performed beyond 48h of the admission. RESULTS: In total 316 patients underwent cholecystectomy. The indication was acute cholecystitis in 113 (36%) patients. Of the 316 patients 289 (92%) were attempted laparoscopically and 30 (10%) were converted to open. Major complications occurred in 44 patients (14%) and mortality rate was 4%. No bile duct injuries were observed. For those patients with mild or moderate acute cholecystitis (n = 103), there was no differences in outcomes when comparing early vs delayed surgery. CONCLUSION: Cholecystectomy in patients≥80 years of age is safe and feasible. Outcomes did not differ between early and delayed surgery for mild/moderate acute cholecystitis.