Laparoscopic inguino-scrotal hernia repair combined with classic hernia sac removal

Emergency Clinical Hospital Târgu Mureș/II Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Tehnology, Târgu Mureș, Romania, The 8th International Medical Congress for Students and Young Doctors, September 24-26, 2020Background. The most effective surgical technique in the pathology of inguinal hernia repair is unknown. The standard method for inguinal hernia repair had changed little over the time until the introduction of synthetic mesh. This mesh can be placed by either using an open approach or by using a minimal access laparoscopic technique. In the inguinal hernia treatment the laparoscopic approach has clear advantages, including less acute and chronic postoperative pain, smaller incisions, or earlier return to work. Case report. 36 year old, male patient without any significant past medical or past surgical history, developed a giant inguino-scrotal hernia, whom we treated using a laparoscopic approach combined with open sac removal with the incision on the scrotum. The mesh was placed preperitoneal following the transabdominal preperitoneal procedure (TAPP). Due to the size of the hernia sac and difficult laparoscopic dissection, we made an incision on the scrotum and we practiced a transscrotal excision of the remaining sac. During the early postoperative period, intensive care treatment was not necessary and no complications were registered. The patient was discharged on postoperative day 3 in an excellent condition without any accusations. After a follow-up of 1 month neither hernia recurrence, nor chronic groin pain, nor sexual disorder were recorded. Conclusions. Different approaches are possible. Open inguinal approach is commonly used in case of giant inguino-scrotal hernias but laparoscopic approach is not impossible. The transscrotal excision of the sac can prevent the formation of hydrocele and the technique can serve the benefits of the laparoscopic treatment in esthetic point of view

Metasztázis miatt végzett máj- és hasfalreszekció 11 évvel a pancreatoduodenectomia után | Resection of liver and abdominal wall metastasis 11 years after pancreatoduodenectomy Case report

Absztrakt: A pancreasrák prognózisa kedvezőtlen. A betegség kiújulása típusosan főleg a posztoperatív első két évben történik. A késői és szoliter metasztázis azonban ritka. Esetünkben egy férfi beteg kórtörténetét mutatjuk be, aki hasnyálmirigyrák miatt radikális műtéten esett át. A betegnél 11 évvel később egy szoliter májmetasztázist diagnosztizáltak, amelyet az épben reszekáltunk. Egy évvel a műtét után betegünk jó általános állapotban van. Esetünk demonstrálja, hogy pancreastumor miatt reszekcióban részesített betegeknél indokolt lehet ismételt műtét késői, izolált metasztázis esetén. Orv Hetil. 2017; 158(28): 1109–1111. | Abstract: Pancreatic cancer has adverse prognosis. Disease recurrence is typical and it occurs mainly within the first 2 years postoperatively. However late and soliter metastases are rare. This case report shows the history of a male patient, who was radically operated on for pancreatic cancer. 11 years later a solitary liver metastasis has developed and it was completely removed by resection. 1 year postoperatively the patient is doing well. Our case demonstrates that in patients after resection for pancreatic cancer, redo surgery might be justified in case of late and isolated metastasis. Orv Hetil. 2017; 158(28): 1109–1111

Endoscopic sphincterotomy for delaying choLecystectomy in mild acute biliarY pancreatitis (EMILY study): Protocol of a multicentre randomised clinical trial

Introduction: According to the literature, early cholecystectomy is necessary to avoid complications related to gallstones after an initial episode of acute biliary pancreatitis (ABP). A randomised, controlled multicentre trial (the PONCHO trial) revealed that in the case of gallstone-induced pancreatitis, early cholecystectomy was safe in patients with mild gallstone pancreatitis and reduced the risk of recurrent gallstone-related complications, as compared with interval cholecystectomy. We hypothesise that carrying out a sphincterotomy (ES) allows us to delay cholecystectomy, thus making it logistically easier to perform and potentially increasing the efficacy and safety of the procedure. Methods/Design: EMILY is a prospective, randomised, controlled multicentre trial. All patients with mild ABP, who underwent ES during the index admission or in the medical history will be informed to take part in EMILY study. The patients will be randomised into two groups: (1) early cholecystectomy (within 6 days after discharge) and (2) patients with delayed (interval) cholecystectomy (between 45 and 60 days after discharge). During a 12-month period, 93 patients will be enrolled from participating clinics. The primary endpoint is a composite endpoint of mortality and recurrent acute biliary events (that is, recurrent ABP, acute cholecystitis, uncomplicated biliary colic and cholangitis). The secondary endpoints are organ failure, biliary leakage, technical difficulty of the cholecystectomy, surgical and other complications