Thoracoscopic-assisted repair of a bochdalek hernia in an adult: a case report

<p>Abstract</p> <p>Introduction</p> <p>Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. Once a Bochdalek hernia has been diagnosed, surgical treatment is necessary to avoid complications such as perforation and necrosis.</p> <p>Case presentation</p> <p>We present a 17-year-old Japanese boy with left-upper-quadrant pain for two months. Chest radiography showed an elevated left hemidiaphragm. Computed tomography revealed a congenital diaphragmatic hernia. The spleen and left colon had been displaced into the left thoracic cavity through a left posterior diaphragmatic defect. We diagnosed a Bochdalek hernia. Surgical treatment was performed via a thoracoscopic approach. The boy was placed in the reverse Trendelenburg position and intrathoracic pressure was increased by CO₂gas insufflations. This is a very useful procedure for reducing herniated contents and we were able to place the herniated organs safely back in the peritoneal cavity. The diaphragmatic defect was too large to close with thoracoscopic surgery alone. Small incision thoracotomy was required and primary closure was performed. His postoperative course was uneventful and there has been no recurrence of the diaphragmatic hernia to date.</p> <p>Conclusion</p> <p>Thoracoscopic surgery, performed with the boy in the reverse Trendelenburg position and using CO₂gas insufflations in the thoracic cavity, was shown to be useful for Bochdalek hernia repair.</p

Le malformazioni congenite dell'apparato respiratorio di interesse chirurgico

The authors report a case of congenital atresia of the apical posterior bronchus of left upper lobe combined with atresia of the apical bronchus of inferior lob

[A modified Thal cardioplasty in the management of advanced esophageal achalasia].

viene presentata una modifica dell'intervento di esofagocardioplastica con patch gastrico secondo thal per il trattamento delle forme avanzate di acalasia esofagea

Resezioni spleniche parziali. descrizione di una tecnica innovativa di emostasi

Total splenectomy increases incidence of infections and fatal sepsis. the authors report an original technique of emostasi

Stapled transanal rectal resection with contour transtar for obstructed defecation syndrome: lessons learned after more than 3 years of single-center activity.

BACKGROUND: Obstructed defecation syndrome (ODS) is a widespread and disabling disease. OBJECTIVE: We want to evaluate the safety and efficacy of Stapled Transanal Rectal Resection (STARR) performed with a new dedicated device in the treatment of ODS. DESIGN: A retrospective review of 187 STARR performed from June 2007 to February 2011 was conducted. SETTINGS: The whole study was conducted at a University Hospital. PATIENTS: All the patients with symptomatic ODS and the presence of a rectocele and/or a recto-rectal or recto-anal intussusception, in the absence of sphincter contractile deficiency, were included in the treatment protocol. INTERVENTIONS: All procedures were performed using Contur Transtar device. We analyze the functional results of this technique and the incidence and features of the surgical and functional complications and how you can prevent or treat them. MAIN OUTCOME MEASURES: Constipation was graded using the Agachan-Wexner constipation score; use of aids to defecate and patient satisfaction were assessed preoperatively and 6 months after surgery. Intraoperative and postoperative complications were also investigated. RESULTS: The constipation intensity was statistically reduced from the preoperative mean value of 15.8 (± 4.9) to 5.2 (± 3.9) at 6 months after surgery (p<0.0001). Of the 151 (80.3%) patients who took laxatives and 49 (26.2%) who used enemas before treatment, only 25 (13.2 %; p<0.0001) and 7 (3.7%; p<0.0001) respectively, continued to do so after surgery. None of the 17 (9.1%) patients who had previously helped themselves with digitation needed to continue this practice. Almost all patients showed a good satisfaction rate (3.87/5) after the procedure. LIMITATIONS: The retrospective design introduces potential selection bias. CONCLUSIONS: The results of this study shows that STARR performed using Contour Transtar is a safe and effective procedure to treat ODS

Topical glyceryl trinitrate ointment for pain related to anal hypertonia after stapled hemorrhoidopexy: a randomized controlled trial.

BACKGROUND: Postoperative pain after stapled hemorrhoidopexy (SH) is cause for considerable concern and may be related to contracture of continence muscles. OBJECTIVE: We compared glyceryl trinitrate (GTN) 0.4% ointment with lidocaine chlorhydrate (LIDO) 2.5% gel as topical therapy to relieve the pain of anorectal muscular spasm after SH. DESIGN: This was a randomized, single-blind, parallel-group and controlled trial. SETTINGS: The study were entirely conducted at the St. Andrea Hospital of Rome, Italy. PATIENTS: Patients suffering postoperative anal pain after SH, with elevated anal resting pressure, were enrolled, excluding those treated for concomitant anorectal disease. INTERVENTIONS: Subjects were randomly assigned to twice-daily locally-applied topical medication (GTN or LIDO) for a total of 14 days. MAIN OUTCOME MEASURES: Pain intensity (at baseline and at Days 2,7, and 14 of therapy) and anal resting pressure (at baseline and at Day 14 of therapy) were quantified by visual analogue scale (VAS) and anorectal manometry (ARM), respectively. RESULTS: Forty-one patients were studied. As specified, VAS scores (Day 2, 2.5±1.0 vs 4.0±1.1, p<0.0001; Day 7, 1.4 vs 2.8, p < 0.0001; Day 14, 0.4 vs 1.4, p = 0.003) and ARM values (baseline, 113±9.3 mmHg vs 113±9.2 mmHg, p=0.754; Day 14, 75.4 ±7.4 mmHg vs 85.6 ±7.9 mmHg, p<0.0001) showed faster, more effective pain relief and reduction in anal resting pressure with GTN vs LIDO. LIMITATIONS: Investigators were not blinded to the treatment groups. ARM was done only on patients suspected of having anal hypertonia at digital rectal examination and who actually had hypertonia may not have been identified. The performance of ARM only at Day 14 of treatment made us lose the possibility to evaluate patients earlier (at Day 7), when pain was more intense. CONCLUSIONS: After SH, topical 0.4% GTN is effective in relieving pain in patients in whom anal hypertonia is identified