Appendiceal Vaginal Fistula: A Rare Complication of Nonoperative Appendicitis Management.

Appendicitis is one of the most common conditions encountered in emergency surgical practice. An appendico-cutaneous fistula is a rare complication of appendicitis. An appendico-vaginal fistula is extremely rare. To our knowledge, based on a thorough review of the literature using PubMed, MEDLINE, and Google Scholar, only three other cases of an appendico-vaginal fistula have been reported. We present one such case in a 43-year-old female with a history of partial hysterectomy, recurrent abscesses that had failed to respond to repeated drainage and antibiotic treatment, and nonoperative treatment of appendicitis.

Laparoscopic transperitoneal repair of flank hernias: a retrospective review of 27 patients.

INTRODUCTION: Incisional hernias of the flank are rare with scattered case reports regarding the feasibility of laparoscopic treatment. Treatment can be technically challenging due to patient positioning and adequate mesh overlap and fixation. The aim of this study is to describe the surgical technique and present outcomes of the largest known case series of laparoscopic repair of flank hernia. METHODS: A retrospective chart review was performed from April 2002 to August 2006 at two university hospitals utilizing three surgeons' experience. All patients who underwent a laparoscopic repair of a flank hernia were identified and reviewed with regards to short-term outcomes. RESULTS: Twenty-seven patients were identified with incisional flank hernia treated laparoscopically. Average defect size was 188 cm(2) repaired with an average mesh size of 650 cm(2). Mean operating room (OR) time was 144 min and mean length of stay (LOS) was 3.1 days. There were two reoperations within the cohort: one for a new, unrelated midline hernia 7 months after repair of the initial flank hernia and one for chronic pain with removal of a previously placed polypropylene mesh in the subcutaneous tissue of the abdominal wall. Neither patient had failure of the laparoscopic flank hernia repair. Two other patients were conservatively treated for chronic pain. Mean follow-up was 3.6 months. CONCLUSIONS: In the laparoscopic repair of flank hernias adequate retroperitoneal dissection and wide mesh overlap is imperative. Laparoscopic repair can be performed safely and effectively with good short-term outcomes.

Hemostasis and hemostatic agents in minimally invasive surgery.

As minimally invasive surgery (MIS) has grown in scope and complexity, new challenges have been introduced along the way, including the need for endoscopic hemostatic techniques. Traditional electrical and mechanical means are still the mainstay, but new technologies for hemostasis continue to emerge. Restricted access to the operative site can limit the use of some tools, and yet multiple chemical hemostats and tamponading agents are used in MIS today. Systemic agents also have been developed and have a role in certain MIS circumstances. These products allow surgeons to continue to approach more difficult procedures using minimally invasive techniques. On the horizon are the newer, even less-invasive approaches of natural orifice endoluminal and transluminal surgery, which will increase the difficulties with reliable hemostat agents and delivery mechanisms.