Mesothelial Cyst of the Round Ligament Misdiagnosed as Irreducible Inguinal Hernia

We report the case of a 36-year-old woman who presented with signs and symptoms of an irreducible inguinal hernia. Surgical exploration revealed a mesothelial cyst of the round ligament of the uterus. Mesothelial cysts of the round ligament are rare lesions, frequently masquerading as inguinal hernias, and should be included in the differential diagnosis of any inguinal mass. Clinical findings are those of a groin mass, discomfort, and bulging. Ultrasound and CT scans often demonstrate an aperistaltic cystic mass. Definitive diagnosis is usually made intraoperatively and confirmed histopathologically

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Short and long term results of surgery for colon cancer: a comparison between total mesocolic excision and conventional resection

During the last decade many efforts have been done in order to improve the oncologic outcomes following colonic resection. Complete mesocolic excision (CME) has been proven of providing high rates of disease free and overall survival times in patients undergoing resection for colonic malignancies. The aim of our study is to further investigate the role of CME in colonic surgery throughout a comparison with a series of conventional resections. METHODS: All data regarding resections for colonic cancer since 2006 were prospectively obtained in two surgical departments. Retrieved data from 290 patients were analysed and compared between those undergone CME and conventional surgery. RESULTS: CME group presented a higher rate of postoperative morbidity and readmissions. Histopathological features were in favourite of CME surgery compared with the conventional group, in terms of resected bowel length (33cm vs 20cm) and lymph node harvest (27 vs 18). Although CME leaded to an improved disease free and overall survival time, only tumor differentiation, adjuvant chemotherapy and age, statistically significant affected the aforementioned outcome values (p< 0.05).CONCLUSION: CME improves histopathologic features, but without presenting oncologic superiority. Larger prospective studies following adequate surgical training are needed to prove the technique’s advantages in oncologic outcomes.Κατά τη διάρκεια της τελευταίας δεκαετίας πραγματοποήθηκαν πολλές προσπάθειες, με σκοπό την αύξηση της ογκολογικής αποτελεσματικότητας μετά από εκτομή του παχέος εντέρου.Η τεχνική της ολικής εκτομής του μεσοκόλου (CME) έχει αποδειχθεί ότι προσφέρει βελτιωμένα ποσοστά διαστήματος ελεύθερο νόσου, καθώς και συνολικής επιβίωσης, σε ασθενείς οι οποίοι χειρουργούνται για νεοπλάσματα παχέος εντέρου.Σκοπός της μελέτης είναι η περαιτέρω διερεύνηση του ρόλου της CME στη χειρουργική του παχέος εντέρου, μέσω της σύγκρισης με την κλασική κολεκτομή. Μέθοδοι: Δημιουργήθηκε μια προοπτική βάση δεδομένων, αναφορικά με τα χειρουργεία του παχέος εντέρου σε δύο χειρουργικές κλινικές, από το 2006 και ένθεν. Τα δεδομένα των ασθενών διαχωρίστηκαν μεταξύ αυτών που υποβλήθηκαν σε κλασική κολεκτομή και αυτών που υπεβλήθηκαν σε ολική εκτομή του μεσοκόλουΑποτελέσματα: Η ομάδα των ασθενών μετά απο εκτομή κατά CME παρουσίασε αυξημένα ποσοστά μετεγχειρητικής νοσηρότητας και επανεισαγωγών. Αντιθέτως ασθενείς μετά από CME εκτομή παρουσίασαν καλύτερα παθολογοανατομικά αποτελέσματα σε σχέση με τους ασθενείς μετά από κλασσική εκτομή και πιο συγκεκριμένα, μεγαλύτερο μήκος εκταμνέντος εντέρου (33cm vs 20cm) και υψηλότερο αριθμό ανευρεθέντων λεμφαδένων (27 vs 18). Εντούτοις, παρόλο που οι ασθενείς μετά από CME εκτομή είχαν βελτιωμένο διάστημα ελεύθερο νόσου, καθώς και συνολική επιβίωση, μόνο η διαφοροποίηση του όγκου, η μετεγχειρητική χημειοθεραπεία και η ηλικία, επηρέασαν στατιστικώς σημαντικά τα προαναφερθέντα διαστήματα (p< 0.05). Συμπέρασμα: Η εκτομή κατά CME βελτιώνει τα παθολογοανατομικά αποτελέσματα, χωρίς όμως να παρουσιάζει ογκολογική υπεροχή. Χρειάζονται μεγαλύτερες προοπτικές μελέτες, μετά από στοχευμενη εκπαίδευση στην τεχνική, για να αποδειχθούν τα τυχόν προτερήματα της τεχνικής αναφορικά με το ογκολογικό αποτέλεσμα

Βραχυπρόθεσμα και μακροπρόθεσμα αποτελέσματα της χειρουργικής του καρκίνου του παχέος εντέρου: σύγκριση μεταξύ της ολικής εκτομής του μεσοκόλου και της συμβατικής εκτομής

Εισαγωγή:Κατά τη διάρκεια της τελευταίας δεκαετίας πραγματοποήθηκαν πολλές προσπάθειες, με σκοπό την αύξηση της ογκολογικής αποτελεσματικότητας μετά από εκτομή του παχέος εντέρου.Η τεχνική της ολικής εκτομής του μεσοκόλου (CME) έχει αποδειχθεί ότι προσφέρει βελτιωμένα ποσοστά διαστήματος ελεύθερο νόσου, καθώς και συνολικής επιβίωσης, σε ασθενείς οι οποίοι χειρουργούνται για νεοπλάσματα παχέος εντέρου.Σκοπός της μελέτης είναι η περαιτέρω διερεύνηση του ρόλου της CME στη χειρουργική του παχέος εντέρου, μέσω της σύγκρισης με την κλασική κολεκτομή. Μέθοδοι: Δημιουργήθηκε μια προοπτική βάση δεδομένων, αναφορικά με τα χειρουργεία του παχέος εντέρου σε δύο χειρουργικές κλινικές, από το 2006 και ένθεν. Τα δεδομένα των ασθενών διαχωρίστηκαν μεταξύ αυτών που υποβλήθηκαν σε κλασική κολεκτομή και αυτών που υπεβλήθηκαν σε ολική εκτομή του μεσοκόλου Αποτελέσματα: Η ομάδα των ασθενών μετά απο εκτομή κατά CME παρουσίασε αυξημένα ποσοστά μετεγχειρητικής νοσηρότητας και επανεισαγωγών. Αντιθέτως ασθενείς μετά από CME εκτομή παρουσίασαν καλύτερα παθολογοανατομικά αποτελέσματα σε σχέση με τους ασθενείς μετά από κλασσική εκτομή και πιο συγκεκριμένα, μεγαλύτερο μήκος εκταμνέντος εντέρου (33cm vs 20cm) και υψηλότερο αριθμό ανευρεθέντων λεμφαδένων (27 vs 18). Εντούτοις, παρόλο που οι ασθενείς μετά από CME εκτομή είχαν βελτιωμένο διάστημα ελεύθερο νόσου, καθώς και συνολική επιβίωση, μόνο η διαφοροποίηση του όγκου, η μετεγχειρητική χημειοθεραπεία και η ηλικία, επηρέασαν στατιστικώς σημαντικά τα προαναφερθέντα διαστήματα (p&lt; 0.05). Συμπέρασμα: Η εκτομή κατά CME βελτιώνει τα παθολογοανατομικά αποτελέσματα, χωρίς όμως να παρουσιάζει ογκολογική υπεροχή. Χρειάζονται μεγαλύτερες προοπτικές μελέτες, μετά από στοχευμενη εκπαίδευση στην τεχνική, για να αποδειχθούν τα τυχόν προτερήματα της τεχνικής αναφορικά με το ογκολογικό αποτέλεσμα.BACKGROUND: During the last decade many efforts have been done in order to improve the oncologic outcomes following colonic resection. Complete mesocolic excision (CME) has been proven of providing high rates of disease free and overall survival times in patients undergoing resection for colonic malignancies. The aim of our study is to further investigate the role of CME in colonic surgery throughout a comparison with a series of conventional resections. METHODS: All data regarding resections for colonic cancer since 2006 were prospectively obtained in two surgical departments. Retrieved data from 290 patients were analysed and compared between those undergone CME and conventional surgery. RESULTS: CME group presented a higher rate of postoperative morbidity and readmissions. Histopathological features were in favourite of CME surgery compared with the conventional group, in terms of resected bowel length (33cm vs 20cm) and lymph node harvest (27 vs 18). Although CME leaded to an improved disease free and overall survival time, only tumor differentiation, adjuvant chemotherapy and age, statistically significant affected the aforementioned outcome values (p&lt; 0.05). CONCLUSION: CME improves histopathologic features, but without presenting oncologic superiority. Larger prospective studies following adequate surgical training are needed to prove the technique’s advantages in oncologic outcomes

Innovations in macroscopic evaluation of pancreatic specimens and radiologic correlation

The purpose of this study was to evaluate the feasibility of a novel dissection technique of surgical specimens in different cases of pancreatic tumors and provide a radiologic pathologic correlation. In our hospital, that is a referral center for pancreatic diseases, the macroscopic evaluation of the pancreatectomy specimens is performed by the pathologists using the axial slicing technique (instead of the traditional procedure with longitudinal opening of the main pancreatic and/or common bile duct and slicing along the plane defined by both ducts). The specimen is sliced in an axial plane that is perpendicular to the longitudinal axis of the descending duodenum. The procedure results in a large number of thin slices (3–4 mm). This plane is identical to that of CT or MRI and correlation between pathology and imaging is straightforward. We studied 70 cases of suspected different solid and cystic pancreatic tumors and we correlated the tumor size and location, the structure—consistency (areas of necrosis—hemorrhage—fibrosis—inflammation), the degree of vessels’ infiltration, the size of pancreatic and common bile duct and the distance from resection margins. Missed findings by imaging or pitfalls were recorded and we tried to explain all discrepancies between radiology evaluation and the histopathological findings. Radiologic-pathologic correlation is extremely important, adding crucial information on imaging limitations and enabling quality assessment of surgical specimens. The deep knowledge of different pancreatic tumors’ consistency and way of extension helps to improve radiologists’ diagnostic accuracy and minimize the radiological-surgical mismatching, preventing patients from unnecessary surgery. Keywords: Pancreas, Neoplasms, MDCT, MRI, Histopathology, Specime

Mesothelial Cyst of the Round Ligament Misdiagnosed as Irreducible Inguinal Hernia

We report the case of a 36-year-old woman who presented with signs and symptoms of an irreducible inguinal hernia. Surgical exploration revealed a mesothelial cyst of the round ligament of the uterus. Mesothelial cysts of the round ligament are rare lesions, frequently masquerading as inguinal hernias, and should be included in the differential diagnosis of any inguinal mass. Clinical findings are those of a groin mass, discomfort, and bulging. Ultrasound and CT scans often demonstrate an aperistaltic cystic mass. Definitive diagnosis is usually made intraoperatively and confirmed histopathologically

Transient Femoral Nerve Palsy Complicating “Blind” Transversus Abdominis Plane Block

We present two cases of patients who reported quadriceps femoris weakness and hypoesthesia over the anterior thigh after an inguinal hernia repair under transversus abdominis plane (TAP) block. Transient femoral nerve palsy is the result of local anesthetic incorrectly injected between transversus abdominis muscle and transversalis fascia and pooling around the femoral nerve. Although it is a minor and self-limiting complication, it requires overnight hospital stay and observation of the patients. Performing the block under ultrasound guidance and injecting the least volume of local anesthetic required are ways of minimizing its incidence

Morphology of the sulcus of the caudate process (Rouviere&apos;s sulcus) in a Greek population and a systematic review with meta-analysis

The purpose of this study was to determine the prevalence and to investigate the morphology of the sulcus of the caudate process in a Greek population, along with a systematic review and meta-analysis of the literature. Overall, 103 consecutive patients undergoing laparoscopic cholecystectomy were included in the analysis. The sulcus was present in 91% and three morphological variants were identified (groove 69%, slit 21% and scar 10%). The sulcus had a horizontal course in 90% of patients and a mean length of 25 +/- 13 mm. The meta-analysis included 27 surgical and 11 cadaveric studies with 6661 cases in total. The pooled prevalence of the sulcus was 80% and did not differ significantly among various geographical regions. Concerning sulcus subtypes, the binary “open/fused” classification was used to unify the heterogeneous data. The “open” type was more frequent than the “fused” (64.5% vs 35.5%). A horizontal course was observed in 53.5% and an oblique in 45.7%. The sulcus contained the right portal pedicle in 38%, the right posterior portal pedicle in 37%, and the right posteroinferior pedicle in 23.5%. In conclusion, the sulcus of the caudate process is a very helpful anatomical landmark in hepatectomy and laparoscopic cholecystectomy and can be identified in the majority of patients. However, various classifications for the morphological variants and diverse terminology cause discrepancy in the literature and create the need for a single classification system. The proposed 3-tier classification (groove, slit, scar) is simple and easy to remember and avoids ambiguous nomenclature