[Anterior jugular vein cavernoma in a forthcoming rupture stage: a case report]

The Authors present a very rare case of left anterior jugular vein cavernoma anterior jugular vein cavernoma in an over-seventy-year-old woman. The patient was visited already in a complicated status occurring as an increasing lateral neck mass. The case is so interesting for several reasons: for the peculiar lesion that belongs, in fact, to the uncommon group of the cavernous hemangiomas; for the exceptional localization on the anterior jugular vein; for the old age of the patient; last, but not least, for the unusual presentation of the forthcoming rupture. A speed healing without complications has been achieved thanks to the immediate diagnosis (it is important to suspect the lesion!), to the imaging techniques and to the surgical approach performed in emergency.

Treatment of morbid obesity and gastroesophageal reflux with hiatal hernia by Lap-Band

BACKGROUND

Esophageal reflux is common in obese patients. Hiatal hernia is considered a potential contraindication to placement of a Lap-Band.

METHODS

Esophageal investigation in patients who were candidates for a Lap-Band included clinical evaluation of symptoms (scoring system), endoscopic and radiologic evaluation, 24-h pH test, and stationary manometry. Patients with gastroesophageal reflux (GER) with or without hiatal hernia underwent the Lap-Band procedure.

RESULTS

GER was diagnosed in 12/40 morbidly obese patients, 11 of whom received a standard Lap-Band (3 patients were radiologically diagnosed with transient hiatal hernia). One patient with a large hiatal hernia underwent closure of the diaphragmatic esophageal hiatus, and the Lap-Band was positioned similarly to an Angelchik prosthesis. All but 1 patient who was lost at follow-up were symptom-free (range 1-24 months).

CONCLUSION

GER with or without hiatal hernia is not a contraindication for obese patients undergoing a Lap-Band procedure. It accomplishes by a single operation satisfactory treatment of these two disturbing diseases.

Follow-up of Lap-Band complications

BACKGROUND

Proximal gastric pouch dilation (PGPD) and band dislocation (BD) are the most frequent complications of laparoscopic adjustable silicone gastric banding (LASGB).

METHODS

Conservative treatment of PGPD and BD was attempted in all patients by deflation of the band. In the case of failure, laparoscopic exploration was performed.

RESULTS

From January 1996 to July 1998, 8 of 40 patients who underwent LASGB experienced PGPD (n = 7) or BD (n = 1). Debanding was performed in 3 patients with PGPD, while in 4 the pouch dilation was successfully treated with deflation of the band. Two patients (PGPD and BD) were treated with band repositioning. Weight loss was not influenced in patients treated conservatively, compared with patients who did not experience complications.

CONCLUSIONS

PGPD and BD are not always responsible for band failure in LASGB. Conservative treatment can be successful, and repositioning of the band is feasible in selected cases.

[Current indications for video-laparoscopic surgery of adrenal gland neoplasms]

Recent advances in pathophysiology of the adrenal glands suggest new indications for adrenalectomy. In open surgery large incisions are needed to remove a small gland; on the contrary, laparoscopic procedures offer new possibilities. The present study is a review of the literature on indications, contraindications and surgical technique of laparoscopic adrenalectomy. Evaluations of these initial experiences are favourable, however, due to the small number of patients operated and to the short follow up, a definitive opinion on the role of laparoscopic surgery for adrenalectomy has to be formulated.