Endoscopic removal of retained large surgical gauze: a case report

In this paper, a 63-year-old woman was reported with recurrent abdominal pain after cholecystectomy. A retained surgical towel was seen by CT-scan in the peritoneal cavity, where it migrated across duodenum wall toward pre-pyloric region of the stomach. Endoscopic removal of the large retained gauze in size of 40 cm x 40 cm was successfully performed without laparotomy and with no complication. In the last years, the main method for removal of retained foreign objects has been open laparotomy or laparoscopy. We claimed that removal of large retained surgical long gauze is actually possible using upper GI endoscopy by expert endoscopists, and, therefore, there is no need for anesthesia or surgery as well as no occurrence of complication and laceration (AU)

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[Up-to-date opportunities of IOL fixation in deficiency of lens capsule support].

Native and foreign literature concerning up-to-date techniques of surgical treatment of aphakia in deficiency of lens capsule support is reviewed Their main advantages and disadvantages are discussed.

[The radical minimal access thoracoplasty by funnel chest in adults].

A new technique of radical thoracoplasty, performed with a small size incision, using the sternocostal complex fixation with nitinol plates with shape memory and the surgical toolkit required for the purpose, has been successfully introduced. 23 patients underwent surgery using the technique. Tree patients had early postoperative complications: 2 cases of exudative pleurisy and 1 case of bronchitis aggravation. Good cosmetic results was achieved in all operated patients. The mechanical ground of the technique is based on the use of the effective force of the sternum traction and the pressure of the plate on the tissues below. The main advantage of the method is avoidance of the transverse sternotomy.

Uraco-cistopexia: nueva técnica de cisto-suspensión asociada al burch para el tratamiento del cistocele e incontinencia urinaria de esfuerzo, seguimiento a largo plazo / Urachus cystopexy: New technique for bladder suspension associated to the Burch`s technique in the treatment of cystocele and stress urinary incontinence. Long-term follow-up

OBJETIVO: Comparar la eficacia y morbilidad a largo plazo de pacientes con incontinencia urinaria de esfuerzo a las que se realizó uretro-cervico-suspensión tipo Burch versus el procedimiento de Burch más uraco-cistopexia.MÉTODOS: Se realizó un análisis de cohorte retrospectivo, longitudinal, comparativo y observacional. De enero de 1994 a marzo 2005 se incluyeron 129 pacientes con incontinencia urinaria de esfuerzo (IUE) o incontinencia urinaria mixta (IUM). Cincuenta y cuatro pacientes fueron sometidas a procedimiento de Burch (grupo B) y 75 pacientes a procedimiento de Burch asociado a uraco-cistopexia (grupo BU). La severidad de la incontinencia fue valorada mediante el número de apósitos utilizados durante 24 hrs. La cura se consideró cuando el paciente no requirió ningún dispositivo para la pérdida urinaria; la mejoría como una disminución a una toalla al día y fracaso el uso de más de 1 apósito en 24 horas. En la IUM, el componente de incontinencia urinaria de urgencia (IUU) se evaluó por separado(AU)

RESULTADOS: Se evaluaron 47 pacientes del grupo B y 67 pacientes del grupo BU; a los 12 meses de seguimiento observando una tasa cura/mejoría de la IUE del 74.4% (29/6) y 97% (58/7) respectivamente, p=0.001 y a los 24 meses de seguimiento 35 pacientes del grupo B y 42 pacientes del grupo BU observando una tasa del 65.7% (22/3) y 97.6% (37/4) respectivamente, p=0.014. La IUM basal se presentó en 53.7% de pacientes del grupo B y en 58.6% pacientes del grupo BU. Se analizó en forma aislada la parte de IUU de estas pacientes; a los 12 meses 53.1% de pacientes del grupo B y 19.4% del grupo BU presentaban IUU, p=0.000 y a los 24 meses 50% de pacientes del grupo B y 26.19% del grupo BU presentaban IUU, p=0.029. La IUU de novo se presentó en 19.14% de pacientes de grupo B y en el grupo BU 5.97%, p=.0000 y a los 24 meses en el grupo B 17.64% de pacientes y en el grupo BU 13.95% p=0.005. Las complicaciones relacionadas a la uraco-cistopexia se presentaron en el trans-operatorio y fue apertura vesical en 3 de los primeros casos que se resolvieron con cistorrafia en dos planos y sonda vesical por espacio de 7 días.CONCLUSIONES: El procedimiento de Burch asociado a la uraco-cistopexia tuvo mayor eficacia en la resolución a largo plazo de la IUE y del componente de IUU que el procedimiento de Burch aislado. La fijación quirúrgica del uraco a la aponeurosis de los rectos anteriores del abdomen mantiene firme la vejiga, lo que probablemente disminuye su desplazamiento durante los esfuerzos, evitando así la tensión en las fijaciones uretro-cervicales, elevando la eficacia del procedimiento de Burch(AU)

OBJECTIVES: To compare long term efficacy and morbidity in patients with stress urinary incontinence treated using Burch’s colpopexy versus Burch’s colpopexy plus urachus-cystopexy.METHODS: Retrospective, longitudinal comparative, observational study in 129 patients with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). Fifty four patients underwent Burch’s colpopexy (group B) and 75 patients underwent Burch’s colpopexy and urachus-cystopexy (group B U). These patients completed inclusion criteria from January 1994 to March 2005.The severity of SUI was evaluated by means of the number of pads used in 24 hours. Cure was defined as patients not using any pad for urinary leakage; improvement, when the number of pads used decreased to one pad a day; and failure when the patients used more than 1 pad in 24 hours. In MUI the urge urinary incontinence (UUI) component was evaluated separately.RESULTS: After 12 months of follow-up, 47 patients of group B and 67 patients of group BU were evaluated analyzing cure/improvement. Either one were observed in 74.4% (29/6) and 97% (58/7) respectively (p= 0.001). At 24 months follow up, in 35 patients of group B and 42 of group BU, a rate of 65.7% (22/3) and 97.6% (37/4) was observed respectively (p=0.014). MUI was present in 53.7% of group B and 58.6% patients of group BU. An independent analysis was made on urge urinary incontinence (UUI) in these patients at 12 months; 53.1 % of group B and 19.4 % of group BU had UUI (p= 0.000). At 24 months, 50% of patients of group B and 26.19% of group BU had UUI (p= 0.029). De novo UUI was present in 19.4% of group B and 5.97% of group BU (p= 0.000) at12 months follow-up, and in 17.64% of patients of group B and 13.95% of group BU (p= 0.005) at 24 months. Complications related to urachus-cystopexy presented trans-operatively: vesical injury in 3 of the initial cases, solved with bladder closure in two layers and vesical catheter for 7 days approximately(AU)

CONCLUSIONS: Burch’s procedure in addition to urachus-cystopexy was better for the treatment of SUI and UUI than Burch’s procedure alone in a long term clinical follow-up. Surgical fixation of the urachus to the anterior abdominal wall provides extra support to the bladder and probably reduces its displacement during strength, avoiding tension of urethral and bladder neck fixations and increasing the efficacy of Burch’s procedure(AU)