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1.
Ann R Coll Surg Engl ; 102(2): 75-83, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31696731

RESUMO

INTRODUCTION: Gynaecological structures such as the ovaries, fallopian tubes, ligaments and uterus are rarely encountered inside a hernial sac. The prevalence of groin hernias containing parts of female genitalia remains unknown. The aim of this review was to summarise the existing evidence on inguinal hernias containing ovaries with or without the other female adnexa. METHODS: A systematic search was conducted for literature published up to February 2018 using the MEDLINE®, Scopus® and Google Scholar™ databases along with the references of the full-text articles retrieved. Papers on observational studies and case reports concerning women who were diagnosed with an ovarian inguinal hernia (pre or intraoperatively) were considered eligible for inclusion in the review. RESULTS: Fifteen papers (13 case reports, 2 case series) comprising seventeen patients (mean age 47.9 years) were evaluated. A left-sided hernia was noted in 13 cases (77%) whereas 4 patients had a right-sided hernia. Eight patients underwent preoperative imaging with computed tomography, ultrasonography or both. This was diagnostic in five cases. In 11 patients, hernia contents were repositioned, 2 had a salpingo-oophorectomy and 2 an oophorectomy. Eight patients underwent hernia repair with mesh placement while three had a herniorrhaphy. CONCLUSIONS: Ovarian inguinal hernias should be considered among the differential diagnoses of a groin mass or swelling. In women of reproductive age, repair of the hernia with the intent to preserve fertility is of critical importance.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Doenças Ovarianas/cirurgia , Ovariectomia , Salpingo-Ooforectomia , Feminino , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/epidemiologia , Herniorrafia/instrumentação , Humanos , Canal Inguinal/diagnóstico por imagem , Canal Inguinal/cirurgia , Doenças Ovarianas/diagnóstico , Doenças Ovarianas/epidemiologia , Ovário/diagnóstico por imagem , Ovário/cirurgia , Prevalência , Telas Cirúrgicas , Tomografia Computadorizada por Raios X , Ultrassonografia
2.
Am Surg ; 85(11): 1262-1264, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775968

RESUMO

Subcutaneous endoscopically assisted ligation (SEAL) technique is an effective and minimally invasive approach for indirect inguinal hernia repair in children. Not all patients are candidates for SEAL because of technical limitations. We hypothesized that preoperatively assessed patient-level factors may predict technical feasibility of SEAL repair. We performed a retrospective review of all patients who underwent indirect inguinal hernia repair between June 2012 and December 2014. All patients younger than two years and any patient older than two years who had a concomitant umbilical hernia were considered candidates for diagnostic laparoscopy with SEAL repair. We compared patients who had SEAL repair with those who had diagnostic laparoscopy with conversion to open repair. Univariate statistics was performed using the chi-squared and Student's t test. One hundred forty-one patients underwent diagnostic laparoscopy with intent to perform a SEAL repair. Seventeen patients were lost to follow-up. Of the remaining 124 patients, 66 had SEAL repairs, 35 had open repairs, and 23 had a SEAL repair with contralateral open repair. Patient age, BMI, gender, history of prematurity, and history of incarcerated hernia were similar between the SEAL and open groups. Sixty-two per cent of hernias were able to be repaired with SEAL technique. Hernia recurrence was seen in 3 of 123 total SEAL repairs and in 1 of 74 open repairs. The recurrence rate for SEAL repairs (2.4%) was not significantly different from the recurrence rate for open repairs (1.4%). No preoperative patient-level factors predicted technical inability to perform a successful SEAL repair. In this series, the recurrence risk of SEAL compared with open repair was low and not statistically significant. For practitioners with minimally invasive experience, SEAL should be considered a safe and successful option for inguinal hernia repair in pediatric patients undergoing routine diagnostic laparoscopy.


Assuntos
Endoscopia/métodos , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Canal Inguinal/cirurgia , Seleção de Pacientes , Índice de Massa Corporal , Pré-Escolar , Conversão para Cirurgia Aberta/estatística & dados numéricos , Endoscopia/estatística & dados numéricos , Feminino , Hérnia Inguinal/diagnóstico por imagem , Herniorrafia/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido Prematuro , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Ligadura/métodos , Masculino , Estudos Retrospectivos , Fatores Sexuais
3.
Niger J Clin Pract ; 22(10): 1457-1458, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607739

RESUMO

Among various reasons of swellings in the female inguinal region nuck canal cysts are rare entities. Abnormal persistence of procesus vaginalis opening cause this formation. Presentation at adults can lead misdiagnosis. Inguinal hernia, tumors (benign or malign), cysts, lymphadenopathies and endometriosis are other common reason for female groin swelling. Once diagnosed surgical excision is definitive treatment.


Assuntos
Cistos/diagnóstico por imagem , Edema/etiologia , Hérnia Inguinal/cirurgia , Canal Inguinal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Cistos/cirurgia , Erros de Diagnóstico , Feminino , Hérnia Inguinal/diagnóstico , Humanos , Canal Inguinal/cirurgia , Resultado do Tratamento , Ultrassonografia
4.
Cir. pediátr ; 32(4): 181-184, oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184106

RESUMO

Objetivos. La anestesia caudal es una técnica que permite la realización de diversos procedimientos quirúrgicos en neonatos y lactantes evitando complicaciones respiratorias y neurotoxicidad asociada a la anestesia general, permitiendo un inicio precoz de la ingesta y una menor estancia hospitalaria. Presentamos la experiencia en un centro terciario. Material y métodos. Estudio retrospectivo en neonatos y lactantes intervenidos de cirugía abdominal o inguinal (2016-2018) mediante anestesia caudal asociada a sedación. Se recogieron datos epidemiológicos, comorbilidad, procedimientos quirúrgicos, tiempo quirúrgico y anestésico, inicio de ingesta, estancia hospitalaria y complicaciones asociadas a la técnica. Resultados. Se intervinieron 87 pacientes menores de 1 año en nuestro centro, en 56 (23 varones, 33 mujeres) se realizó cirugía bajo anestesia caudal (37 programadas,19 urgentes), edad media 2 meses (0-11). En 25 se asociaba prematuridad, 3 traqueomalacia severa, un paciente monitorización de apneas y 8 displasia broncopulmonar. Procedimientos: hernia inguinal no complicada (34), hernia inguinal incarcerada (9), torsión testicular (5), piloromiotomía (8). Tiempo medio de cirugía 35 minutos (15-80), tiempo anestésico de 30 min (20-60) y tiempo quirúrgico total 60 min (40-120). La ingesta se inicio a las 2 horas salvo un paciente que precisó antieméticos. El alta hospitalaria se produjo a las 24 horas (12-36). No se registraron complicaciones durante la realización de la anestesia caudal ni necesidad de conversión a anestesia general. Conclusiones. Consideramos la anestesia caudal de elección en neonatos y lactantes en determinadas cirugías, con escasa morbilidad asociada. Permite un rápido inicio de la ingesta acortando la estancia hospitalaria y minimiza las complicaciones respiratorias y neurotoxicidad a largo plazo, incluso en pacientes prematuros con comorbilidad grave


Objectives. Caudal anesthesia is a safe and effective technique in children. Some surgical procedures, such as abdominal or inguinal surgeries, could be performed avoiding general anesthesia in newborns and babies, reducing the risk of respiratory depression and neurotoxicity. Our objective is to analyze the experience in a tertial referral center. Material and methods. We carried a retrospective study in patients under 1 year of age who underwent abdominal or inguinal procedures under caudal regional anesthesia, between 2016 and 2018. Demographics, diagnosis, comorbidity, surgical procedure, operation time, oral intake, perioperative complications and hospital stay were recorded. Results. We included 87 patients under 1 year of age. In 56 patients (23 males, 33 females) surgery was performed under caudal anesthesia (37 scheduled, 19 urgent). Mean age was 2 months (0-11). Comorbidity: 25 associated prematurity, 3 severe tracheomalacia, 1 apnea and 8 bronchopulmonary dysplasia. Surgical procedures: 34 inguinal hernia repair, 9 incarcerated inguinal hernias, 5 neonatal testicular torsions, 8 pyloromyotomies. Mean operation time was 35 min (15-80) and mean anesthetic time 30 min (20-60). Oral intake started 2 h after surgery in 55 patients. Discharge was given in 24 h (12-36). Complications were not noticed. Any patient needed conversion to general anesthesia. Conclusions. Caudal anesthesia should be the anesthetic technique of choice in newborns and babies who undergo abdominal or inguinal surgeries, especially in those with comorbidity. This procedure could be performed safely, avoiding respiratory or neurological complications, with a fast recovery of patients and short hospital stay


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Anestesia Caudal/métodos , Canal Inguinal/cirurgia , Abdome/cirurgia , Tempo de Internação , Estudos Retrospectivos , Traqueomalácia/complicações
5.
J Obstet Gynaecol Res ; 45(9): 1918-1924, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31264339

RESUMO

AIM: To demonstrate the efficacy and safety of a modified technique of laparoscopic inguinal ligament suspension (LILS) with hysterectomy for the treatment of uterovaginal prolapse. METHODS: A total of 57 patients were treated by LILS combined with hysterectomy between Jan 2014 and Feb 2016. The perioperative parameters, such as operative time, estimated blood loss, length of stay and intra- and postoperative complications were recorded. The Pelvic Organ Prolapse questionnaire classification was applied to evaluate the Pelvic Organ Prolapse stage, and Patient Global Impression of Improvement scale was used to determine the patients' satisfaction. Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire were used to evaluate the functional improvement. All data were collected preoperatively and then at 12 months postoperatively. RESULTS: The mean surgical time was 130.4 (82-190) min, the average blood loss was 50.4 (10-300) mL and the mean hospitalization was 5.3 (4-8) days. The rates of intra- and postoperative complications were low. After a minimal of 12 months follow-up, the anatomical success rate was 85.5%, and the subjective satisfaction rate was 92.7%. The functional measures also presented a significant improvement with no recurrence of prolapse. CONCLUSION: LILS combined with hysterectomy was a safe and effective technique and might be considered as an alternative treatment for patients with uterovaginal prolapse.


Assuntos
Histerectomia/métodos , Canal Inguinal/cirurgia , Laparoscopia/métodos , Ligamentos/cirurgia , Prolapso Uterino/cirurgia , Doenças Vaginais/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Diafragma da Pelve/cirurgia , Inquéritos e Questionários , Resultado do Tratamento , Vagina/patologia , Vagina/cirurgia
6.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296635

RESUMO

Amyand's hernia is a rare entity where the appendix is trapped within inguinal canal. For even rarer are the cases where the appendix has perforated and caused an abscess into inguinal canal. Here we report a case where a male patient had Amyand's hernia, acute appendicitis and abscess which were treated by laparotomy. We present the diagnostic process and intraoperative finding leading to diagnosis of Amyand's hernia.


Assuntos
Abscesso/complicações , Abscesso/diagnóstico por imagem , Apendicite/complicações , Apendicite/diagnóstico por imagem , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico por imagem , Abscesso/cirurgia , Doença Aguda , Adulto , Apendicectomia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Canal Inguinal/diagnóstico por imagem , Canal Inguinal/cirurgia , Masculino , Tomografia Computadorizada por Raios X/métodos
7.
Int J Surg ; 68: 11-19, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31185313

RESUMO

BACKGROUND: Inguinal hernia repair is one of the most frequent operations in pediatric surgery and is increasingly performed laparoscopically. The latter introduced new momentum in the debate on the necessity of contralateral exploration, as the rates of contralateral patent processus vaginales and metachronous inguinal hernias determine whether a routine closure would be overtreatment or useful prevention. MATERIALS AND METHODS: We searched MEDLINE via PubMed, Web of Science and Scopus at the 6th of September 2017; reference lists and CrossRef were snowballed for reports citing identified studies. Eligibility criteria were age <18 years, preoperative diagnosis of unilateral hernia, laparoscopic evaluation, and publication since January 2012. Studies using hernioscopy (transinguinal laparoscopy) were excluded. We reported our systematic review following PRISMA criteria. RESULTS: We included 32 reports consisting of 19,188 pediatric patients diagnosed with unilateral inguinal hernia. Of these, 38.5% (95% confidence interval: 34%-43.1%) had a contralateral open processus vaginalis concomitantly found during laparoscopic inguinal hernia repair. A secondary analysis using nine studies that compared open and laparoscopic approaches found that prophylactic closure of contralateral patent processus vaginales resulted in a risk difference of 5.7% (95% confidence interval: 3.6%-7.7%; P < 0.001) following 2691 (42.8%) procedures (nine studies: Ten of 6282 patients operated laparoscopically had a metachronous hernia, versus 286 of 5764 with open hernia repair). CONCLUSIONS: Prophylactic closure of a contralateral patent processus vaginalis reduces the number of metachronous inguinal hernias, but about 18 procedures must be performed to prevent one metachronous inguinal hernia, indicating that the indication should be based on personal circumstances of the patient.


Assuntos
Anormalidades Congênitas/diagnóstico , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Canal Inguinal/anormalidades , Laparoscopia/métodos , Criança , Pré-Escolar , Anormalidades Congênitas/cirurgia , Feminino , Hérnia Inguinal/congênito , Hérnia Inguinal/prevenção & controle , Humanos , Lactente , Canal Inguinal/cirurgia , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos
8.
J Coll Physicians Surg Pak ; 29(5): 406-409, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036106

RESUMO

OBJECTIVE: To compare mean postoperative pain post-Lichenstein open hernioplasty with and without ilioinguinal neurectomy at six months. STUDY DESIGN: Randomised controlled trail. PLACE AND DURATION OF STUDY: Surgical Unit-I, Benazir Bhutto Hospital, Rawalpindi, from August 2014 to February 2015. METHODOLOGY: Adult male patients with unilateral reducible inguinal hernia, who consented to the study between the age range of 18-80 years, were included. Recurrent, irreducible or strangulated, or large inguinal-scrotal hernia and those with previous abdominal incision, impaired cognition, peripheral neuropathy, limited mobility and females were excluded. Patients were equally randomised to nerve-preservation and excision groups. Mann-Whitney U-test was applied to find out difference in inguinodynia at 1 and 6 months. RESULTS: There was significant difference in pain at 1 month in the nerve-preservation group (Md=6.00, IQR=4, n=90) and nerve excision group (Md=3.50, IQR=4, n=90), U=2308.00, z=-5.017, p<.001 and at 6 months in the nerve preservation group (Md=2.00, IQR=1, n=90) and nerve-excision group (Md=0.00, IQR=1, n=90), U=3001.00, z=-3.470, p=0.001. CONCLUSION: Prophylactic ilioinguinal neurectomy significantly reduces groin pain at 6 month as compared to nerve preservation group following Lichenstein hernioplasty.


Assuntos
Denervação , Virilha/inervação , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Canal Inguinal/inervação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Herniorrafia/efeitos adversos , Humanos , Canal Inguinal/cirurgia , Masculino , Pessoa de Meia-Idade , Neuralgia , Medição da Dor , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Período Pós-Operatório , Telas Cirúrgicas , Resultado do Tratamento , Adulto Jovem
9.
Medicine (Baltimore) ; 98(22): e15862, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145338

RESUMO

BACKGROUND: To compare the clinical feasibility and oncological outcomes of video endoscopic inguinal lymph node dissection (VE-ILND) and open inguinal lymph node dissection (O-ILND) in the management of penile cancer. METHODS: We searched published articles in the PubMed, Embase, Cochrane Library, Web of science, China National Knowledge Infrastructure, and Wanfang databases. Data were extracted by 2 independent authors, and meta-analysis was performed by using Review Manager software version 5.3. RESULTS: Ten studies were included. Compared with the O-ILND group, the VE-ILND group exhibited less intraoperative blood loss (standardized mean difference [SMD] = 3.12; 95% confidence intervals [95% CIs] [1.27, 4.98]; P = .001), shorter hospital stay (SMD = 1.77; 95% CIs [0.94, 2.60]; P < .001), shorter drainage time (SMD = 2.69; 95% CI [1.47, 3.91]; P < .001), reduced wound infection rate (odds ratio [OR] = 10.62; 95% CI [4.01, 28.10]; P < .001); reduced skin necrosis rate (OR = 7.48; 95% CI [2.79, 20.05]; P < .001), lower lymphedema rate (OR = 3.23; 95% CI [1.51, 6.88]; P = .002), equivalent lymphocele rate (OR = 0.83; 95% CI [0.31, 2.23]; P = .720), and parallel recurrence rate (OR = 1.54; 95% CI [0.41, 5.84]; P = 0.530). However, the number of dissected lymph nodes (OR = 0.25; 95% CI [0.03, 0.47]; P = .030) was slightly increased in the O-ILND group. GRADE recommendations of primary outcomes were shown in a summary of findings table. CONCLUSIONS: For perioperative outcomes, VE-ILND is superior to O-ILND. For short-term oncological outcomes, VE-ILND is comparable to O-ILND. However, long-term oncological control still requires further verification.


Assuntos
Endoscopia/métodos , Canal Inguinal/cirurgia , Excisão de Linfonodo/métodos , Neoplasias Penianas/cirurgia , Cirurgia Vídeoassistida/métodos , Estudos de Viabilidade , Humanos , Tempo de Internação , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Neoplasias Penianas/patologia , Resultado do Tratamento
10.
Plast Surg Nurs ; 39(2): 41-43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136556

RESUMO

Given their high rate of complications, radical surgical procedures of anorectal and gynecological tumors require a reliable and individualized reconstruction. The latter is influenced by the frequent indication of adjuvant chemo/radiotherapy that they present. We describe the case of a patient with medical history of vulvar carcinoma that required radical surgery and bilateral inguinal lymphadenectomy. Because of the stage of the tumor, the application of postoperative radiotherapy was clinically indicated; however, after surgery, the patient developed bilateral inguinal ulcers that made postoperative radiotherapy application impossible. Using a radical surgical approach in combination with postoperative radiotherapy increases survival in patients with these types of tumors. Therefore, delaying its use because of wound complications or inadequate reconstruction cannot be justified. The pedicled abdominal rectus flap is an excellent option for this purpose in patients with moderate- to large-sized defects.


Assuntos
Canal Inguinal/cirurgia , Retalhos Cirúrgicos/cirurgia , Neoplasias Vulvares/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/normas , Adulto , Feminino , Humanos , Radioterapia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Reto do Abdome/cirurgia , Resultado do Tratamento
12.
J Pediatr Surg ; 54(7): 1505-1509, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30827487

RESUMO

BACKGROUND: The desire of pediatric surgeon to reduce incision related morbidity and pain while achieving good cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES] and needlescopic surgery. Intracorporeal suturing and knot tying during SIPES remain challenging. The aim of this study is to introduce a novel and simple technique for intracorporeal suturing of the pediatric inguinal hernia after needlescopic disconnection of hernia sac using just needles rather than laparoscopic instruments. It is an imitation of the principles of sewing machine. METHODS: The first author discussed the idea of the technique with the coauthors and a demonstration was done on a Silicon Pad before application of the technique on children with congenital inguinal hernia [CIH] for peritoneum closure after needlescopic disconnection of the hernia sac. The main outcome measures were feasibility of the technique, suturing and knotting time and recurrence rate. RESULTS: The sutures were snugly applied to the ridges of Silicon Pad with good approximation and the knot was firmly tightened in all experiments. After applying and mastering the technique on a Silicon Pad, we shifted to use it on 373 children with 491 hernia defects. All operations were completed by the needlescopic technique without the need for insertion of any laparoscopic instruments. The time required for suturing of the peritoneum around internal inguinal ring [IIR] and knot tying, decreased considerably from 6 min 27 s in the first operation to less than 4 min after the fifth operation and stabilized at approximately 4 min 30 s. No major intraoperative complication. There was no recurrence during a mean follow-up period of 19.6 ±â€¯1.2 months. CONCLUSION: The closure of the peritoneum around the IIR using needles mimicking what is happening in sewing machine suturing is a feasible, safe and effective line of treatment of children with CIH. The cosmetic results are 42 outstanding without any recurrence.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Técnicas de Sutura , Pré-Escolar , Estudos de Viabilidade , Feminino , Hérnia Inguinal/congênito , Humanos , Canal Inguinal/cirurgia , Complicações Intraoperatórias/etiologia , Laparoscopia/instrumentação , Masculino , Agulhas , Duração da Cirurgia , Peritônio/cirurgia , Recidiva , Técnicas de Sutura/instrumentação
13.
Int J Gynecol Cancer ; 29(2): 444-445, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30718318

RESUMO

This video article demonstrates an inguino-abdominal combined approach for laterally extended pelvic resection, a major surgical procedure for locally advanced primary or recurrent gynecological cancer infiltrating the pelvic sidewall, for which palliative therapy is the only alternative.1 After local institutional review board approval (protocol No CICOG 02/03/62), we made a step by step surgical video of an inguino-abdominal combined approach for laterally extended pelvic resection , defined as an en bloc resection of a pelvic tumor with pelvic sidewall structures, including the iliopsoas and/or obturator internus muscles.2 3 The patient, a 48-year-old woman, diagnosed with single pelvic platinum resistant recurrence after five lines of chemotherapy for serous ovarian cancer G3, International Federation of Gynecology and Obstetrics (FIGO) stage IIIC, BRCA wild type. The preoperative positron emission tomography/computed tomography scan detected uptake on the right side at the level of the external iliac region and obturator fossa: the tumor surrounded the right external iliac vessels by more than 50% of their circumferences, with possible involvement of the vascular wall and venous vascular compression (Tinelli's score=4).4 The tumor extended towards the obturator fossa, with possible involvement of the inguinal canal. Due to an uncertain pathological response, the size of the recurrence, and its close contiguity with the ureter and bowel, we decided to avoid radiation therapy as it could result in a ureteral or intestinal fistula. We performed a laterally extended pelvic resection, as shown step by step in the video.The procedure was conducted until complete removal of recurrence (R0). Estimated blood loss was 1000 mL and total operative time was 240 min. The patient was discharged after 15 days; we reported a urinary infection, a likely postoperative complication. The pathology report described a lymphnodal relapse of ovarian cancer (diameter=6 cm) with infiltration of surrounding tissue and in the sano margins. Six months after surgery, the patient is alive without evidence of relapse.The borders of pelvic surgical anatomy are continually extending, requiring surgeons to use a personalized approach and to continually update their anatomic knowledge. In this context, laterally extended pelvic resection could be a feasible surgical procedure, representing a salvage treatment in recurrent or persistent primary gynecological malignancies infiltrating the pelvic sidewall, when other approaches have failed. However, additional clinical trials are needed to confirm these results.3.


Assuntos
Abdome/cirurgia , Cistadenocarcinoma Seroso/cirurgia , Canal Inguinal/cirurgia , Neoplasias Ovarianas/cirurgia , Neoplasias Pélvicas/cirurgia , Abdome/patologia , Cistadenocarcinoma Seroso/patologia , Feminino , Humanos , Canal Inguinal/patologia , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Pélvicas/patologia , Prognóstico , Gravação em Vídeo
14.
Ann Surg Oncol ; 26(4): 1134-1141, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30725310

RESUMO

BACKGROUND: Inguinal lymph node metastases (ILNM) from rectal adenocarcinoma are rare and staged as systemic disease. This study aimed to provide insight into the treatment and prognosis of ILNM from rectal adenocarcinoma. METHODS: All patients with a diagnosis of synchronous or metachronous ILNM from rectal adenocarcinoma between January 2005 and March 2017 were retrospectively reviewed. RESULTS: The study identified 27 patients with ILNM (15 with synchronous and 12 with metachronous disease). After discussion by a multidisciplinary tumor board, 19 patients were treated with curative intent, 17 of whom underwent inguinal lymph node dissection. Of the 17 patients, 12 had locally advanced rectal cancer (LARC) with isolated ILNM, 3 had LARC and metastases elsewhere, and 2 had locally recurrent rectal cancer (LRRC). The median overall survival (OS) for all the patients treated with curative intent was 27 months [95% confidence interval (CI) 11.6-42.4 months], with a 5-year OS rate of 34%. The median OS for the patients with LARC and isolated ILNM (n = 12) was 74 months (95% CI 18.0-130.0 months), with a 5-year OS rate of 52%. All the patients with metastases elsewhere (n = 3) or LRRC (n = 2) experienced recurrent systemic disease. Eight patients were treated with palliative intent. The median OS for this group was 13 months (95% CI 1.9-24.1 months), with a 3-year OS rate of 0%. CONCLUSION: Clinicians should not consider ILNM as an incurable systemic disease. Patients with primary rectal cancer and solitary ILNM who were eligible for curative surgical treatment had a 5-year survival rate of 52%. The prognosis for patients with additional systemic metastases or LRRC is worse, and the benefit of surgery is unclear.


Assuntos
Adenocarcinoma/cirurgia , Canal Inguinal/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/cirurgia , Adenocarcinoma/secundário , Adulto , Idoso , Feminino , Seguimentos , Humanos , Canal Inguinal/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Neoplasias Retais/patologia , Estudos Retrospectivos , Taxa de Sobrevida
15.
J Laparoendosc Adv Surg Tech A ; 29(4): 568-572, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30676267

RESUMO

BACKGROUND: Sliding indirect inguinal hernias containing ovary are not uncommon in girls. We reported our experience with laparoscopic treatment of inguinal ovarian hernias in female infants and children with the aim to standardize the surgical technique. METHODS: The medical records of all girls who underwent laparoscopic inguinal hernia repair in our unit over the past 5 years were retrospectively reviewed. Only patients with an ovary found intraoperatively in the hernia sac were included in the study. All patients younger than 1 year received preoperatively a bowel preparation with simethicone and enemas. RESULTS: A total of 289 girls (median age 3.2 ± 0.5 years) underwent laparoscopic inguinal hernia repair during the study period. Thirty-seven patients (12.8%) had an ovarian hernia and were included in the study. Of these 37 girls, 9 (28.1%) were younger than 1 month, 20 (62.5%) ranged in age from 2 months to 1 year, and 3 (9.4%) were from 1 to 7 years. The average operative time was 23.7 minutes (range 18-43 minutes). No necrotic ovary was found intraoperatively, and all the procedures were accomplished laparoscopically. Neither intraoperative nor postoperative complications were reported. A patency of the contralateral canal of Nuck was found in 16 of the 37 patients (43.2%) and repaired during the same procedure. The average length of hospitalization was 21.8 hours (range 18-36 hours). No hernia recurrence or ovarian atrophy was recorded at a mean follow-up of 36 months (range 1-60 months). CONCLUSIONS: On the basis of our experience, laparoscopy should be considered the gold standard for the treatment of inguinal ovarian hernias in girls. Key points for standardization of the technique are as follows: bowel preparation in children younger than 1 year, use of 5-mm umbilical balloon trocar, correct positioning of 3-mm working screw trocars, section of the abnormal attachment of ovarian suspensory ligament, section of the periorificial peritoneum, and use of nonresorbable sutures.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Doenças Ovarianas/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Canal Inguinal/cirurgia , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos
16.
Int Braz J Urol ; 45(2): 325-331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676302

RESUMO

INTRODUCTION: Video endoscopic inguinal lymphadenectomy - VEIL - has emerged as an alternative to reduce post-surgical complications (PSC) in patients with penile cancer submitted to inguinal lymphadenectomy (IL). In some series, these PSC are observed in more than 50% of patients. The objectives of the present study are to describe the initial experience of VEIL in a Hospital in Teresina, PI, Brazil, and to analyze PSC incidence. MATERIAL AND METHODS: Retrospective descriptive study of patients submitted to VEIL from March 2014 to November 2015. Data were collected regarding surgical time, bleeding, complications, lymph node number, conversion, global complications, drainage time, cellulitis, lymphocele, cutaneous necrosis, miocutaneous necrosis and hospitalization time. RESULTS: 20 lower limbs of 11 patients were operated. Mean age was 51.4 (24-72) years. Mean surgical time was 85 (60-120) minutes. No patient showed intrasurgical complications, bleeding > 50 mL or conversion. Three surgeries evolved with lower limb edema, 2 with lymphoceles and one patient had cutaneous necrosis and another bulging of surgical wound. Mean time of hospitalization was 4 (2-11) days. A mean of 5.8 (1-12) lymph nodes were dissected in each surgery. CONCLUSION: VEIL is a safe and easy technique with lower incidence of PSC that can be reproduced in small centers.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Canal Inguinal/cirurgia , Excisão de Linfonodo/métodos , Neoplasias Penianas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cirurgia Vídeoassistida/métodos , Adulto , Idoso , Brasil/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Adulto Jovem
17.
J Urol ; 201(2): 378-385, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30053512

RESUMO

PURPOSE: Gubernaculum sparing laparoscopic orchiopexy, which involves anatomical delivery of the testis through the internal inguinal ring, has been proposed as an alternative to conventional laparoscopic Fowler-Stephens orchiopexy, maximizing collateral blood supply and potentially decreasing atrophy rates. We compared the 2 techniques to test this hypothesis. MATERIALS AND METHODS: The primary (dependent) outcome of the study was rate of testicular atrophy, which was defined as palpation of a nubbin or inability to palpate a testis (complete atrophy) on postoperative physical examination at 3 and 12 months. Doppler ultrasound was obtained routinely to further confirm the diagnosis of testicular atrophy. Independent variables that were captured were age at surgery, type of procedure (conventional laparoscopic Fowler-Stephens orchiopexy vs gubernaculum sparing laparoscopic orchiopexy), surgical approach (single vs 2-stage), location of intra-abdominal testis (high vs low) and patency of the internal inguinal ring. RESULTS: Mean ± SD age at surgery was 25.7 ± 13.3 months (median 22). Laparoscopy was carried out for nonpalpable testes and revealed vanishing intra-abdominal testes in 120 cases (29%), peeping testes in 80 (19%) and intra-abdominal testes in 212 (51%), with 104 being low and 108 being high in the abdomen. A single stage procedure was performed in 44 cases (21%) and a 2-stage procedure in 168 (79%). Based on surgeon preference, conventional laparoscopic Fowler-Stephens orchiopexy was undertaken in 46 patients (22%) and gubernaculum sparing laparoscopic orchiopexy in 166 (78%). Overall testicular atrophy rate was 6.6% (14 of 212 cases). Atrophy was observed in 13 of 46 testes after conventional laparoscopic Fowler-Stephens orchiopexy and 1 of 166 following gubernaculum sparing laparoscopic orchiopexy (28.3% vs 0.6%, p <0.01). CONCLUSIONS: Gubernaculum sparing laparoscopic orchiopexy is a feasible alternative to conventional laparoscopic Fowler-Stephens orchiopexy. Our findings suggest that preservation of additional vascular supply to the testis (cremasteric vessels and deferential artery) may translate into improved testicular survival rates following laparoscopic orchiopexy.


Assuntos
Criptorquidismo/cirurgia , Gubernáculo/cirurgia , Laparoscopia/métodos , Orquidopexia/métodos , Tratamentos com Preservação do Órgão/métodos , Cavidade Abdominal/diagnóstico por imagem , Cavidade Abdominal/cirurgia , Músculos Abdominais/irrigação sanguínea , Criança , Pré-Escolar , Criptorquidismo/diagnóstico por imagem , Humanos , Lactente , Canal Inguinal/cirurgia , Masculino , Estudos Prospectivos , Testículo/diagnóstico por imagem , Testículo/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler
18.
J Surg Res ; 233: 420-425, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502281

RESUMO

BACKGROUND: Femoral hernia repair has various surgical methods. However, controversy still exists regarding the best method for management. This study aimed to compare the infrainguinal with the inguinal approach in the treatment of femoral hernias. MATERIALS AND METHODS: Eighty patients with primary unilateral femoral hernias were prospectively randomized to either the infrainguinal (n = 40) or inguinal approach groups (n = 40). Patient demographics, operative time, duration of hospital stay, postoperative complications, and recurrence rate were recorded. RESULTS: There were no statistically significant differences between both study groups with respect to the patients' demographics and associated comorbidities. Regarding inpatient outcomes, there were no differences between the infrainguinal and inguinal approach groups concerning the postoperative duration of stay (P = 0.248), urinary retention (P = 0.494), superficial wound infection (P = 0.494), seroma (P = 0.615), foreign body sensation (P = 0.615), and chronic pain (P = 0.359). However, total complications were encountered in 3 patients (7.5%) in the infrainguinal approach group compared to 11 patients (27.5 %) in the inguinal approach group (P = 0.037). Also, the mean operative time was significantly shorter in the infrainguinal approach group compared to that in the inguinal group (P < 0.001). Throughout the 15 mo median follow-up duration, there was no recurrence in the inguinal approach group and one (2.5%) recurrence in the infrainguinal approach group (P = 1.000). CONCLUSIONS: In patients undergoing elective primary femoral hernia repair, the infrainguinal approach has a similar clinical curative effect to that of the inguinal approach. However, the former has the advantages of simple operation, short operation time, and fewer complications.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Hérnia Femoral/cirurgia , Herniorrafia/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Seguimentos , Herniorrafia/efeitos adversos , Humanos , Incidência , Canal Inguinal/cirurgia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Recidiva , Resultado do Tratamento
19.
J Pediatr Surg ; 54(1): 177-183, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30482540

RESUMO

BACKGROUND/PURPOSE: Inguinal hernia repair and orchidopexy are among the most common operations in boys. The impact on future fertility has not been conclusively defined. This study evaluates sperm quality after previous inguinal surgery. METHODS: Spermiograms of men with a desire to conceive children were analyzed. History of previous inguinal surgery (hernia repair, orchidopexy, varicocele ligation) was correlated with sperm quality. Other influential factors (age, BMI, chronic medication, tobacco use) were also tested. RESULTS: A total of 333 patients were included. Overall, 12.6% of the subjects had undergone previous inguinal surgery. Of these, 17 (43%) were inguinal hernia repairs, 8 (20%) orchidopexies, and 6 (15%) varicocele ligations, while 9 (22%) could not give an exact history. Abnormal spermiograms were found in 60% (n = 24) of those with previous inguinal surgery versus 48% in controls (p = 0.16). On multivariate analysis, pathologic spermiogram parameters were associated with previous inguinal surgery, orchidopexy, use of chronic medication, and smoking, but NOT with inguinal hernia or varicocele repair alone. CONCLUSIONS: Previous inguinal hernia or varicocele repair does not seem to impact negatively on quality of sperm later in life. Orchidopexy, smoking, and use of chronic medication, however, were all associated with pathologic sperm quality parameters. TYPE OF STUDY: Prospective comparative study. LEVEL OF EVIDENCE: Level II.


Assuntos
Fertilidade , Herniorrafia/efeitos adversos , Canal Inguinal/cirurgia , Orquidopexia/efeitos adversos , Análise do Sêmen/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Hérnia Inguinal/cirurgia , Humanos , Ligadura/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Varicocele/cirurgia , Adulto Jovem
20.
Andrologia ; 51(2): e13188, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30397905

RESUMO

Various studies have been reported to predict the success of varicocelectomy. Neutrophil-lymphocyte ratio (NLR) is a frequently used indicator of systemic inflammation. We aimed to evaluate the effect of inflammation on the success of varicocelectomy using the NLR. The data of 86 patients who underwent varicocelectomy for infertility were evaluated retrospectively. Pre-operative demographic characteristics of patients, laboratory results such as haemogram, and semen analysis and clinical data were recorded. The semen analysis with the highest total motile sperm count was accepted as pre-operative value. Control was performed with semen analysis at post-operative 6th month. As described in previous studies, in our study, more than 50% increase in total motile sperm count in post-operative semen analysis was defined as a significant improvement. However, at least a 100% increase was required for patients with a total motile sperm count <5 million in the definition of recovery. Patients were divided into two groups as those with improvement in the semen parameters (Group 1) and those without (Group 2). NLR was statistically significantly higher in Group 2 compared with Group 1. The area under the curve (AUC) in the ROC curve for NLR was 0.89. According to the Youden index, the best cut-off value of NLR for varicocelectomy success was 1.98 (sensitivity: 94.7%, specificity: 75.9%, p < 0.001). Logistic regression analysis showed that NLR (odds ratio: 3.6, 95% confidence interval: 1.69-8.38, p < 0.001) is independent predictor factors in predicting the success of varicocelectomy. The results of this study show that systemic inflammation adversely affects the likelihood of improvement in sperm parameters by varicocelectomy. Additionally, NLR has been shown to be an independent factor in the prediction of varicocelectomy success.


Assuntos
Infertilidade Masculina/cirurgia , Canal Inguinal/cirurgia , Linfócitos , Microcirurgia/métodos , Neutrófilos , Varicocele/cirurgia , Adulto , Humanos , Infertilidade Masculina/sangue , Contagem de Leucócitos , Masculino , Prognóstico , Varicocele/sangue , Adulto Jovem
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