Coincidence of right adrenal vein and retroaortic left renal vein variations in a patient undergoing laparoscopic adrenalectomy

In this case, we report an interesting right adrenal vein variation with renovascular variations discovered during the laparoscopic right adrenalectomy. A Sixth eightyear-old woman was referred for treatment of a right adrenal mass. Computed tomography sections revealed 3x4.5x3.5 cm well defined right adrenal mass and retroaortic left renal vein. Conventional laparoscopic transabdominal approach was scheduled. During the laparoscopic exploration It was noted that there was no vein drainage from adrenal gland to the inferior vena cava. As this dissection completed, right adrenal vein was exposed arisen from accessory right hepatic vein. In some reports ıt has been reported that adrenal vein variations can be associated with retroaortic left renal vein, but the right adrenal vein joined with an accessory right hepatic vein and retroaortic left renal vein combination is extremely uncommon condition

Treatment of chronic anal fissure: Is open lateral internal sphincterotomy (LIS) a safe and adequate option?

Summary: Background: Anal fissure which is defined as a longitudinal tear in anoderm under the dentate line is one of the most common benign diseases of anorectal area, and due to the severe pain during the defecation and emotional stress that it causes may reduce people's quality of life. There are several treatment methods such as medical substances and surgical procedures. In this retrospective study, we aimed to evaluate the safe and adequate option of lateral internal sphincterotomy (LIS) in chronic anal fissure treatment. Methods: This study is a retrospective study in which 417 patients who were treated for chronic anal fissure were included. Results: Of 417 patients included in the study, 228 (54.7%) were female and the mean ± SD age was 36.1 ± 8.96 years (ranging from 17 to 73 years). Major complaints of patients; pain, bleeding, constipation, pruritus, perianal discharge.Recurrence occurred in 15 patients (3.6%) (12 males, three females) and eight patients (1.9%) developed incontinence (four with gas, four with soiling and seven females, one male). The complaints of all patients with gas incontinence and a patient with fluid incontinence regressed, whereas three patients had permanent fluid incontinence. Conclusion: LIS is still the gold standard for the treatment of chronic anal fissure when the physicians would like to avoid recurrence and obtain the best pain relief. Keywords: Chronic anal fissure, Incontinence, LIS, Recurrence, Satisfactio