Long-Term Outcome of Laparoscopic Totally Extraperitoneal Repair of Bilateral Inguinal Hernias with a Large Single Mesh.

BACKGROUND: A totally extraperitoneal (TEP) approach is currently the technique of choice for the laparoscopic repair of bilateral inguinal hernias in our institution. Most other surgeons use two meshes for the TEP repair, one for each side. We prefer a large single mesh when possible since it allows for easier correct placement of the mesh in one stage. We compared our long-term results of both techniques in terms of late complications and recurrence rates. METHODS: This study retrospectively evaluated the medical records of 108 patients who underwent bilateral laparoscopic TEP repair in our institution between January 2002 and December 2003. Excluded were patients who had a conversion to a transabdominal preperitoneal or open approach. A total of 73 (67 %) patients fulfilled study entrance criteria and were enrolled: 39 had undergone single mesh repair and 34 had undergone double mesh repair. RESULTS: There were no significant group differences in demographics, operating time, postoperative morbidity, or hospital stay. Likewise, after a median follow-up of 102 months (range 94­115 months), there were no significant group differences between the single and double mesh groups in persistent pain (5.8 vs 2.5 %, respectively; p = 0.476) and recurrence (7.6 vs 8.8 %, respectively; p = 0.55). CONCLUSION: The use of a large single mesh is an effective and safe alternative technique for TEP repair of bilateral inguinal hernias, and is technically easy to perform.

Initial experience with ovarian vein embolization for the treatment of chronic pelvic pain syndrome.

BACKGROUND: Ovarian vein embolization was recently suggested as the preferred treatment for chronic pelvic pain syndrome. OBJECTIVE: To evaluate the technical feasibility, complications and early clinical and radiographic results of ovarian vein embolization in women with pelvic pain syndrome. METHODS: Percutaneous transcatheter ovarian vein embolization with coils was performed in six patients aged 27-53 years who presented with pelvic pain syndrome. All had lower abdominal pain, and pelvic varicosities were found on Doppler ultrasound and retrograde ovarian vein venography. Embolization was done unilaterally in three patients (on the left side) and bilaterally in three. Mean follow-up by telephone questionnaire was 7.3 months. RESULTS: The procedure was technically successful in all patients. Two patients reported partial relief of symptoms (33.3%) and three had complete relief (50%), for a total of 5 patients (83.3%) with some measure of improvement. There were no complications following the procedure. CONCLUSIONS: Percutaneous transcatheter ovarian vein embolization seems to be safe and feasible for the treatment of pelvic pain syndrome. The procedure is performed on an outpatient basis and is well tolerated by patients.

Sonographic diagnosis of a giant aneurysm of the common hepatic artery.

Hepatic artery aneurysms are rare vascular lesions sometimes found incidentally during abdominal imaging. We present the case of a 61-year-old man whose initial symptoms were tenderness in the right upper quadrant of the abdomen and epigastric pain. Gray-scale sonography revealed ascites and an 8.1-cm mass in the region of the porta hepatis; color Doppler sonography revealed a turbulent arterial waveform with high peak systolic velocity. We diagnosed a giant aneurysm of the common hepatic artery. Three-dimensional CT angiography confirmed this diagnosis and also revealed hemoperitoneum. The patient underwent aneurysmectomy and recovered well. This case shows that the use of both sonography and CT angiography offers a promising alternative to conventional angiography for the diagnosis of and treatment planning for hepatic artery aneurysms.