Endoscopic resection of a retroperitoneal schwannoma: case report.

INTRODUCTION: Retroperitoneal schwannomas are rare tumors. The symptoms are usually non-specific and these lesions can only be demonstrated with advanced radiological methods. Posterior and anterior approaches can be used to remove retroperitoneal schwannomas. Traditional techniques carry significant risks. CASE REPORT: A 35-year-old man was admitted with a history of right leg pain of 3 months duration. He had received conservative treatment and physical therapy but none of these measures had been helpful. Findings on physical and neurological examinations were all within normal limits. Magnetic resonance imaging revealed a retroperitoneal mass lesion medial to the right psoas muscle at the level of the S1 vertebra. The tumor was removed using an endoscopic transabdominal approach. CONCLUSION: The endoscopic transabdominal approach is a safe, efficient and minimally invasive procedure compared to traditional methods also to remove retroperitoneal schwannomas in selected cases.

Nonopioid analgesics shorten the duration of postoperative ileus.

Morphine inhibits propagating and stimulates nonpropagating colon contractions in monkeys and humans. The use of morphine or other opioids that inhibit propulsive contractions prolongs postoperative ileus. In contrast, ketorolac tromethamine, a nonsteroidal analgesic, has no effect on colon contractions in monkeys. In 14 patients having elective abdominal operations, bipolar electrodes were implanted on the right (n = 13) and left (n = 10) colon. Group A (n = 8) received ketorolac, 30 mg IM q6h, for pain relief. Group B (n = 6) needed supplemental morphine, 2-10 mg IV or IM, plus ketorolac to control their pain. Myoelectric activity was recorded from each subject on postop Days 1-5 and analyzed by computer for electrical control activity (ECA), short and long electrical response activity (ERA), and propagation of long ERA. There was a difference between the two groups in return of propagated long ERA bursts that correlated with clinical recovery from postoperative ileus. Postoperative analgesia with ketorolac resulted in faster resolution of ileus compared to morphine plus ketorolac because opioid-induced motor abnormalities in the colon were avoided.

Inguinal cord lipomas.

Fatty tissue within the internal cremasteric fascia is frequently encountered during hernia surgery, and it is called a cord lipoma in the surgical literature. Between 1997 and 2001, 128 consecutive patients with 139 indirect inguinal hernias, who underwent open repair, were evaluated. A total of 100 lipomas of the spermatic cord or round ligament were identified and resected in 92 patients. There were no reported neoplastic changes noted in histopathologic examinations of the specimens. The incidence of cord lipoma associated with indirect inguinal hernia was 72.5%. Average body mass index (BMI) was 25.7 in patients with lipoma and 24.6 in patients without lipoma ( P=0.048). The incidence of cord lipoma in large hernias (Nyhus Type II and IIIb) was higher in our patients ( P<0.005). It can be clearly seen during laparoscopic exploration of the preperitoneal space that cord lipoma is a continuation of extraperitoneal fat tissue. We believe that even if there is no peritoneal sac, the herniation of extraperitoneal fat through the inguinal canal should be counted as an inguinal hernia, and it requires treatment.

Post-traumatic duodenopancreatectomy in a child.

We describe a 5-year-old boy who complained of severe abdominal pain after a car accident. He was sitting on the lap of the driver and his abdomen was pressed closely between the pregnant driver and the steering wheel. At operation, associated injuries to the duodenum and pancreas were detected which could not be repaired. The transected pancreas and extensive duodenal injury underwent a Whipple-type reconstruction. On postoperative day six, the patient was re-operated due to extensive liver necrosis which was detected on abdominal computerized tomography and a partial liver resection was performed. He was discharged on day 16 after the second operation and has done well so far.

Open-window laparotomy during a transperitoneal approach to the lower lumbar vertebrae: new method for reducing complications.

There are numerous approaches for exploring the lower lumbar vertebrae, and the anterior transperitoneal route is one of the most popular. Like all surgical techniques, this approach has advantages and disadvantages. It provides direct access to the target tissue through a small incision, exposes the anterior portion of the vertebrae well, and permits good visualization of the major vessels, thus reducing risk of vascular injury and life-threatening hemorrhage. However, compared to the extraperitoneal route, the transperitoneal approach carries higher risks for peritoneal complications. This article describes a new practical method for creating an extraperitoneal passageway or "window" during transperitoneal approaches to the lower lumbar vertebrae. Isolation of the peritoneal cavity and its contents with this technique can reduce peri- and postoperative abdominal complications.

The Biology and Anatomy of Inguinofemoral Hernia.

The purpose of this article is to discuss the biology of hernia and covers such features as the male predominance of hernia, the causal significance of a patent processus vaginalis, the effect of the shape of the skeleton on liability to the development of hernia, and the alterations in collagen structure and metabolism that may be involved in the genesis of hernia. In addition, the influence of such factors as peritoneal dialysis, appendectomy, and pregnancy are reviewed. The anatomy of the groin is outlined in detail. The lower abdominal region is a layered structure; the defect in musculoaponeurotic continuity that leads to a hernia exists only in the transversus abdominis layer. The external oblique and internal oblique layers are not primarily involved in the genesis of hernia. The major structures within the transversus abdominis layer are described and illustrated including the deep inguinal ring, iliopubic tract, transversus abdominis arch, femoral sheath, and Cooper's ligament. The structure of the inguinal canal and spermatic cord, and the continuities of investing fascia from the abdominal wall to the spermatic cord are also described in detail. The essential features of anatomic repair of groin hernias are reviewed. Anatomic repairs are always conducted within the transversus abdominis lamina. The structures that need to be apposed in primary repair are specified.

Human colonic smooth muscle electrical activity during and after recovery from postoperative ileus.

Colon smooth muscle electrical control (ECA) and response activities (ERA) were recorded for up to 4 wk postoperatively for 48 patients after major abdominal operations. Bipolar electrodes were implanted into right and left colon circular muscle and exteriorized through the flanks, and signals were tape recorded for 2-24 h daily beginning on the 1st postoperative day. A computer program was used for data reduction and analysis. Recorded signals were digitized and filtered. The ECA frequency components were identified by fast Fourier transformation, and their relative tenancy in low, mid, and high frequency ranges was determined. Short and long ERA burst duration and frequency and number and velocity of propagating long ERA bursts were determined. ECA was omnipresent and exhibited a downshift of the dominant frequency from the mid to the low range as recovery from postoperative ileus progressed. Concurrently, first in the right and then in the left colon, the frequency of long ERA bursts increased, followed by the appearance of propagating long ERA. After the 6th postoperative day, no further significant changes in parameters of colon electrical activity occurred with time.