1
|
Meroni M, Scaglioni MF. The use of superficial circumflex iliac perforator (SCIP) pedicle vein for lymphovenous anastomosis to treat inguinal lymphatic fistula: A case report. Microsurgery 2024; 44:e31181. [PMID: 38651643 DOI: 10.1002/micr.31181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/23/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
The management of lymphatic fistulas following surgical procedures, in particular after inguinal lymphadenectomy, represents a significant clinical challenge. The current case report shows the novel use of the superficial circumflex iliac perforator (SCIP) pedicle vein for lymphovenous anastomosis (LVA) to treat a chronic inguinal lymphatic fistula in a 58-year-old male patient. This patient had developed a persistent lymphorrhea and wound dehiscence after a right inguinal lymph node biopsy performed for oncological reasons 1.5 months before. Pre-operative assessment with indocyanine green (ICG) lymphography confirmed a substantial lymphatic contribution to the wound discharge, thus guiding the surgical strategy. During the procedure, a pedicled tissue segment containing the SCIV was dissected and utilized to fill the wound's dead space and facilitate LVA with the leaking lymphatic vessel. Notably, a coupler device was employed for the anastomosis due to the large caliber of the lymphatic vessel involved, a technique not commonly reported in lymphatic surgeries. The result of the procedure was successful, with intra-operative ICG imaging confirming the patency of the anastomosis. After surgery the wound healed without complications. This case illustrates the potential of SCIV employment in lymphatic fistula repair in the inguinal region. While further research is needed to validate these findings, this report provides an unconventional approach to a relatively common problem in clinical practice.
Collapse
Affiliation(s)
- Matteo Meroni
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Mario F Scaglioni
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Zentrum für Plastische Chirurgie, Pyramid Clinic, Zurich, Switzerland
| |
Collapse
|
2
|
Ozambela M, McCormick BZ, Rudzinski JK, Pieretti AC, González GMN, Meissner MA, Papadopoulos JN, Adibi M, Matin SF, Dahmen AS, Spiess PE, Pettaway CA. Robotic or open superficial inguinal lymph node dissection as staging procedures for clinically node negative high risk penile cancer. Urol Oncol 2024; 42:120.e1-120.e9. [PMID: 38388244 DOI: 10.1016/j.urolonc.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To evaluate perioperative and oncologic outcomes of a cohort of clinically node negative high-risk penile cancer patients undergoing robotic assisted inguinal lymph node dissection (RAIL) compared to patients undergoing open superficial inguinal lymph node dissection (OSILND). PATIENTS AND METHODS We retrospectively reviewed the clinical characteristics and outcomes of clinically node negative high-risk penile cancer patients undergoing RAIL at MDACC from 2013-2019. We sought to compare this to a contemporary open cohort of clinically node negative patients treated from 1999 to 2019 at MDACC and Moffit Cancer Center (MCC) with an OSILND. Descriptive statistics were used to characterize the study cohorts. Comparison analysis between operative variables was performed using Fisher's exact test and Wilcoxon's rank-sum test. The Kaplan-Meier method was used to estimate survival endpoints. RESULTS There were 24 patients in the RAIL cohort, and 35 in the OSILND cohort. Among the surgical variables, operative time (348.5 minutes vs. 239.0 minutes, P < 0.01) and the duration of operative drain (37 vs. 22 days P = 0.017) were both significantly longer in the RAIL cohort. Complication incidences were similar for both cohorts (34.3% for OSILND vs. 33.3% for RAIL), with wound complications making up 33% of all complications for RAIL and 31% of complications for OSILND. No inguinal recurrences were noted in either cohort. The median follow-up was 40 months for RAIL and 33 months for OSILND. CONCLUSIONS We observed similar complication rates and surgical variable outcomes in our analysis apart from operative time and operative drain duration. Oncological outcomes were similar between the two cohorts. RAIL was a reliable staging and potentially therapeutic procedure among clinically node negative patients with penile squamous cell carcinoma with comparable outcomes to an OSILND cohort.
Collapse
Affiliation(s)
- Manuel Ozambela
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Barrett Z McCormick
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jan K Rudzinski
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Matthew A Meissner
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John N Papadopoulos
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mehrad Adibi
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Surena F Matin
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aaron S Dahmen
- Department of Urology at University of Chicago, Chicago, IL
| | - Philippe E Spiess
- Department of Genitourinary Oncology at Moffit Cancer Center, Tampa, FL
| | - Curtis A Pettaway
- Department of Urology at The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
3
|
Haghgoo A, Faegh A, Mostafavi SRS, Zamani HR, Ghahremani M. Inguinal endometriosis: a case series and review of the literature. J Med Case Rep 2024; 18:83. [PMID: 38429816 PMCID: PMC10908077 DOI: 10.1186/s13256-024-04400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/19/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Inguinal endometriosis is one of the most common forms of endometriosis. The present study introduces 8 cases of inguinal endometriosis and discusses probable theories of inguinal endometriosis by reviewing the literature. CASE PRESENTATION 8 Iranian cases of inguinal endometriosis with a mean age of 36 years were presented. Catamenial groin pain and swelling were the most common complications. Also, patients usually had accompanying symptoms such as pelvic pain and dysmenorrhea. One-half of patients had a history of previous abdominal surgery. Ultrasound was diagnostic in 4 patients (50%), and magnetic resonance imaging was used in two patients (25%). Among 6 patients who underwent hormonal therapy, 4 experienced an endometriosis size increase. Inguinal endometriosis was right-sided in 87.5% of patients, and among 4 patients who underwent surgery, 75% had proximal site involvement of the round ligament. CONCLUSION According to the rarity of inguinal endometriosis, it is more likely to be a misdiagnosis with other inguinal disorders such as inguinal hernia. Inguinal endometriosis should be considered in patients who undergo inguinal herniorrhaphy, with suspected findings such as thickening of the hernia sac wall, bloody fluid inside the sac, or thickening of the extraperitoneal round ligament during the surgery.
Collapse
Affiliation(s)
- Ameneh Haghgoo
- School of Medicine, Nikan Hospital, Iran University of Medical Sciences, Aqdasiyeh, Army Boulevard, 22nd Bahman Street, Tehran, Iran.
| | - Ali Faegh
- School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Hamid Reza Zamani
- Department of Radiology, Imam Hossein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | |
Collapse
|
4
|
Wyatt J, Powell SG, Ahmed S, Arthur J, Altaf K, Ahmed S, Javed MA. Inguinal lymph node metastases from rectal adenocarcinoma: a systematic review. Tech Coloproctol 2023; 27:969-978. [PMID: 37233960 PMCID: PMC10562269 DOI: 10.1007/s10151-023-02826-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE Inguinal lymph nodes are a rare but recognised site of metastasis in rectal adenocarcinoma. No guideline or consensus exists for the management of such cases. This review aims to provide a contemporary and comprehensive analysis of the published literature to aid clinical decision-making. METHODS Systematic searches were performed using the PubMed, Embase, MEDLINE and Scopus and Cochrane CENTRAL Library databases from inception till December 2022. All studies reporting on the presentation, prognosis or management of patients with inguinal lymph node metastases (ILNM) were included. Pooled proportion meta-analyses were completed when possible and descriptive synthesis was utilised for the remaining outcomes. The Joanna Briggs Institute tool for case series was used to assess the risk of bias. RESULTS Nineteen studies were eligible for inclusion, encompassing 18 case series and one population-based study using national registry data. A total of 487 patients were included in the primary studies. The prevalence of ILNM in rectal cancer is 0.36%. ILNM are associated with very low rectal tumours with a mean distance from the anal verge of 1.1 cm (95% CI 0.92-1.27). Invasion of the dentate line was found in 76% of cases (95% CI 59-93). In patients with isolated inguinal lymph node metastases, modern chemoradiotherapy regimens in combination with surgical excision of inguinal nodes are associated with 5-year overall survival rates of 53-78%. CONCLUSION In specific subsets of patients with ILNM, curative-intent treatment regimens are feasible, with oncological outcomes akin to those demonstrated in locally advanced rectal cancers.
Collapse
Affiliation(s)
- James Wyatt
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK.
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L1 8JX, UK.
| | - Simon G Powell
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L1 8JX, UK
| | - Salma Ahmed
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - James Arthur
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - Kiran Altaf
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - Shakil Ahmed
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - Muhammad Ahsan Javed
- Department of Colorectal Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| |
Collapse
|
5
|
Singh A, Chauhan E, Kalantri A, Gupta S. Hydrocele and endometriosis of the canal of Nuck in two adults: a look at the imaging features. BMJ Case Rep 2023; 16:e255970. [PMID: 37852666 PMCID: PMC10603436 DOI: 10.1136/bcr-2023-255970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
We present a report of two adult females who presented to the surgery clinic at different time frames in our hospital with a swelling in the inguinal region. The swelling was painful for one of our patients. The first patient was evaluated with a contrast-enhanced CT and an MRI, while the second patient underwent a ultrasonography and an MRI. Imaging revealed the structure to be cystic in nature and confirmed the diagnosis as a hydrocele of the canal of Nuck in both patients. Our second patient was also found to have concomitant endometriosis, with internal septations seen in the hydrocele. Aspiration revealed altered blood with haemosiderin deposition, which established a diagnosis of endometriosis of the canal of Nuck. The first patient underwent excision, while the second patient refused a surgical approach and opted for medical management for endometriosis.
Collapse
Affiliation(s)
- Anmol Singh
- Department of Cardiology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Ekta Chauhan
- Department of Radiology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Amrita Kalantri
- Department of Radiology, Government Medical College and Hospital, Chandigarh, Punjab, India
| | - Sanjay Gupta
- General Surgery, Government Medical College and Hospital, Chandigarh, Chandigarh, India
| |
Collapse
|
6
|
Bakshi GK, Pal M, Jain DK, Arora A, Tamhankar A, Maitre P, Murthy V, J A, Agrawal A, Menon S, Joshi A, Spiess PE, Prakash GJ. Surgical templates for inguinal lymph node dissection in cN0 penile cancer: A comparative study. Urol Oncol 2023; 41:393.e9-393.e16. [PMID: 37507285 DOI: 10.1016/j.urolonc.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/04/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Modified and superficial inguinal lymph node dissection (MILD and SILD) are the 2 widely used templates for surgical staging of clinically node negative (cN0) penile cancer (PeCa); however, no previous reports have compared their outcomes. We compared these 2 surgical templates for oncological outcomes and complications. MATERIALS AND METHODS We retrospectively reviewed records of cN0 PeCa patients who underwent MILD/SILD at our cancer care center from January 2013 to December 2019. Patients who developed a penile recurrence during follow up were excluded from analysis of oncological outcomes. The 2 groups (MILD and SILD) were compared for baseline clinico-pathological characteristics. The primary outcome was the groin recurrence free survival (gRFS). Secondary outcomes included the false negative rate (FNR) and disease free survival (DFS) for both templates and also the post-operative wound related complication. RESULTS Of the 146 patients with intermediate and high risk N0 PeCa, 74 (50.7%) and 72 (49.3%) underwent MILD and SILD respectively. The 2 groups were comparable with regards to the distribution of T stage, tumor grade and the proportion of intermediate and high-risk patients. At a median follow up of 34 months (47 for SILD and 23 for MILD), a total of 5 groin recurrences were encountered; all of them occurred in the MILD group. The gRFS and DFS for the MILD group was 93.2% and 91.8% respectively; while that for the SILD group was 100% and 94.4% respectively. Too few events had occurred to determine any statistically significant difference. The FNR for MILD and SILD was 26.3% and 0% respectively. The overall complication rate was significantly higher in the SILD group (46% vs 20.3%, p=0.001), especially for Clavien Dindo 3A complications. CONCLUSION MILD can fail to pick up micro-metastatic disease in a small proportion of cN0 PeCa patients, while SILD provides better oncological clearance with no groin recurrences. This oncological superiority comes at the cost of a higher incidence of wound-related complications.
Collapse
Affiliation(s)
- Ganesh K Bakshi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mahendra Pal
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Deep Kumar Jain
- Assistant Professor, MGM Medical College and Super-speciality Hospital, Indore, India
| | - Amandeep Arora
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwin Tamhankar
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Arunkumar J
- Department of Clinical Research, JIPMER, Puducherry, India
| | - Archi Agrawal
- Department of Nuclear Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Mumbai, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Gagan J Prakash
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| |
Collapse
|
7
|
Tobias-Machado M, Ornellas AA, Hidaka AK, Medina LG, Mattos PAL, Besio RS, Abreu D, Castro PR, Nishimoto RH, Astigueta J, Dourado A, Machado RD, Magnabosco WJ, Corona-Montes V, Villoldo GM, Zampolli HC, Taha A, Auad PR, Faria EF, Arantes PBO, Tavares A, Nascimento FSMS, Brazão ES, Rocha MM, Costa WH, Panico V, Reis LO, Almeida-Carrera RJ, Silva RC, Zequi SC, Calixto JRR, Sotelo R. Long-term oncological and surgical outcomes after Video Endoscopic Inguinal Lymphadenectomy (VEIL) in patients with penile cancer. Int Braz J Urol 2023; 49:580-589. [PMID: 37390124 PMCID: PMC10482462 DOI: 10.1590/s1677-5538.ibju.2023.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE To report outcomes from the largest multicenter series of penile cancer patients undergoing video endoscopic inguinal lymphadenectomy (VEIL). MATERIALS AND METHODS Retrospective multicenter analysis. Authors of 21 centers from the Penile Cancer Collaborative Coalition-Latin America (PeC-LA) were included. All centers performed the procedure following the same previously described standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease and those with non-fixed palpable lymph nodes less than 4 cm in diameter. Categorical variables are shown as percentages and frequencies whereas continuous variables as mean and range. RESULTS From 2006 to 2020, 210 VEIL procedures were performed in 105 patients. Mean age was 58 (45-68) years old. Mean operative time was 90 minutes (60-120). Mean lymph node yield was 10 nodes (6-16). Complication rate was 15.7%, including severe complications in 1.9% of procedures. Lymphatic and skin complications were noted in 8.6 and 4.8% of patients, respectively. Histopathological analysis revealed lymph node involvement in 26.7% of patients with non-palpable nodes. Inguinal recurrence was observed in 2.8% of patients. 10y- overall survival was 74.2% and 10-y cancer specific survival was 84.8%. CSS for pN0, pN1, pN2 and pN3 were 100%, 82.4%, 72.7% and 9.1%, respectively. CONCLUSION VEIL seems to offer appropriate long term oncological control with minimal morbidity. In the absence of non-invasive stratification measures such as dynamic sentinel node biopsy, VEIL emerged as the alternative for the management of non-bulky lymph nodes in penile cancer.
Collapse
Affiliation(s)
- Marcos Tobias-Machado
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | | | - Alexandre K Hidaka
- Centro Universitário Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | - Luis G Medina
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pablo A L Mattos
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | - Juan Astigueta
- Universidad Privada Antenor Orrego, Instituto Regional de Enfermedades Neoplásicas Norte, Trujillo, Perú
| | - Aurus Dourado
- Associação Piauiense de Combate ao Câncer - Hospital São Marcos, Teresina, PI, Brasil
| | | | | | | | | | | | - Anis Taha
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | - Pericles R Auad
- Instituto do Cancer Arnaldo Vieira de Carvalho, São Paulo, SP, Brasil
| | | | | | | | | | | | | | - Walter H Costa
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Leonardo O Reis
- UroScience, Escola de Ciências Médicas, Universidade de Campinas - UNICAMP, Campinas, SP, Brasil
- Pontifícia Universidade Católica de Campinas - PUC, Campinas, SP, Brasil
| | | | - Rafael C Silva
- Universidade Federal do Maranhão - UFMA, Maranhão, MA, Brasil
| | - Stênio C Zequi
- AC Camargo Cancer Center, São Paulo, SP, Brasil
- National Institute for Science and Technology in Ocogenomic and Therapeutic Innovation INCIT/INOTE AC Camargo Cancer Center, São Paulo, SP, Brasil
| | | | - Rene Sotelo
- USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
8
|
De la Fuente Hagopian A, Guadarrama-Sistos Vazquez S, Farhat S, Reddy NK, Trakhtenbroit MA, Echo A. The emerging role of MRI neurography in the diagnosis of chronic inguinal pain. Langenbecks Arch Surg 2023; 408:319. [PMID: 37594580 DOI: 10.1007/s00423-023-03050-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Chronic pain is a frequent and notable complication after inguinal hernia repair, it has been extensively studied, but its management and diagnosis are still difficult. The cause of chronic pain following inguinal hernia surgery is usually multifactorial. This case series highlights the utility of MRI neurography (MRN) in evaluating the damage to inguinal nerves after a hernia repair, with surgical confirmation of the preoperative imaging findings. MATERIALS AND METHODS A retrospective review was performed on patients who underwent inguinal mesh removal and triple denervation of the groin. Inclusion criteria included MRI neurography. All patients underwent surgical exploration of the inguinal canal for partial or complete mesh removal and triple denervation of the groin by the same senior surgeon. RESULTS A total of nine patients who underwent triple denervation were included in this case series. MRN was then performed on 100% of patients. The postoperative mean VAS score adjusted for all patients was 1.6 (SD p), resulting in a 7.5 score difference compared to the preoperative VAS score (p). Since chronic groin pain can be a severely debilitating condition, diagnosis, and treatment become imperative. CONCLUSION MRN can detect direct and indirect signs of neuropathy even in the absence of a detectable compressive cause aids in management and diagnosis by finding the precise site of injury, and grading nerve injury to aid pre-operative assessment for the nerve surgeon. Thus, it is a valuable diagnostic tool to help with the diagnosis of nerve injuries in the setting of post-inguinal hernia groin pain.
Collapse
Affiliation(s)
- Alexa De la Fuente Hagopian
- Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, TX, USA
| | | | - Souha Farhat
- Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, TX, USA
| | | | - Michael A Trakhtenbroit
- Department of Radiology, Houston Methodist Hospital, Houston, TX, USA
- Weill Cornell Medicine, New York, NY, USA
| | - Anthony Echo
- Division of Plastic Surgery, Department of Surgery, Houston Methodist Hospital, 6560 Fannin, Suite 2200, Scurlock Tower, Houston, TX, USA.
- Texas A&M Medicine, College Station, TX, USA.
- Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
9
|
Cianci MC, Tocchioni F, Mantovani A, Ghionzoli M, Morini F. Unexpected Pediatric Uretero-Inguinal Hernia: Case-Report and Literature Review. Urology 2023; 176:178-182. [PMID: 36841359 DOI: 10.1016/j.urology.2023.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/27/2023]
Abstract
Uretero-inguinal hernia (UIH) is a rare condition in children. We present our experience with an unexpected UIH in a male infant with associated anomalies and a literature review of pediatric cases. A full-term male newborn was referred to our hospital for microcolon and right hydroureteronephrosis. Voiding cystourethrography showed grade-IV right vesicoureteral reflux and a dilated, convoluted, ureter protruding in the right inguinal canal, suggesting a right UIH, which was uneventfully repaired at 2 months of life. UIH is a rare type of inguinal hernia in children that pediatric urologists and surgeons should be aware of. In experienced hands, and when preoperatively suspected, surgical management is safe and effective.
Collapse
Affiliation(s)
- Maria Chiara Cianci
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy; Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Francesca Tocchioni
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Alberto Mantovani
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Marco Ghionzoli
- Department of Pediatric Surgery, Meyer Children's Hospital IRCCS, Florence, Italy; Department of Surgical, Medical, Molecular Pathology and of the Critical Area, University of Pisa, Adolescent and Young Adults Surgery Division, Pisa, Italy
| | - Francesco Morini
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy; Neonatal Surgery Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| |
Collapse
|
10
|
Sun Y, Jiang W, Lin Y, Huang Y, Chi P. Organ preservation with local excision and indocyanine green fluorescence imaging guided video endoscopic inguinal lymphadenectomy for rectal cancer with bilateral inguinal lymph node metastasis-a video vignette. Colorectal Dis 2023; 25:1296-1298. [PMID: 36719257 DOI: 10.1111/codi.16495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Yanwu Sun
- Department of Colorectal Surgery, Fujian Medical University, Union Hospital, Fuzhou, China
| | - Weizhong Jiang
- Department of Colorectal Surgery, Fujian Medical University, Union Hospital, Fuzhou, China
| | - Yu Lin
- Department of Colorectal Surgery, Fujian Medical University, Union Hospital, Fuzhou, China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University, Union Hospital, Fuzhou, China
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University, Union Hospital, Fuzhou, China
| |
Collapse
|
11
|
Bada M, Crocetto F, Nyirady P, Pagliarulo V, Rapisarda S, Aliberti A, Boccasile S, Ferro M, Barone B, Celia A. Inguinal lymphadenectomy in penile cancer patients: a comparison between open and video endoscopic approach in a multicenter setting. J Basic Clin Physiol Pharmacol 2023; 34:383-389. [PMID: 36933235 DOI: 10.1515/jbcpp-2023-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/25/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES To compare differences of operative outcomes, post-operative complications and survival outcomes between open and laparoscopic cases in a multicenter study. METHODS This was a retrospective cohort study performed at three European centers from September 2011 to January 2019. The surgeon decision to perform open inguinal lymphadenectomy (OIL) or video endoscopic inguinal lymphadenectomy (VEIL) was done in each hospital after patient counselling. Inclusion criteria regarded a minimum follow-up of 9 months since the inguinal lymphadenectomy. RESULTS A total of 55 patients with proven squamous cell penile cancer underwent inguinal lymphadenectomy. 26 of them underwent OIL, while 29 patients underwent VEIL. For the OIL and VEIL groups, the mean operative time was 2.5 vs. 3.4 h (p=0.129), respectively. Hospital stays were lower in the VEIL group with 4 vs. 8 days in OIL patients (p=0.053) while number of days requiring drains to remain in situ was 3 vs. 6 days (p=0.024). The VEIL group reported a lower incidence of major complications compared to the OIL group (2 vs. 17%, p=0.0067) while minor complications were comparable in both groups. In a median follow-up period of 60 months, the overall survival was 65.5 and 84.6% in OIL and VEIL groups, respectively (p=0.105). CONCLUSIONS VEIL is comparable to OIL regarding safety, overall survival and post-operative outcomes.
Collapse
Affiliation(s)
- Maida Bada
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Vicenza, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology - Federico II University of Naples, Naples, Italy
| | - Peter Nyirady
- Department of Urology, Semmelweis University, Budapest, Budapest, Italy
| | - Vincenzo Pagliarulo
- Department of Urology, Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Puglia, Italy
| | - Sebastiano Rapisarda
- Department of Urology, Pederzoli Hospital Private Clinic SpA, Peschiera del Garda, Veneto, Italy
| | - Antonio Aliberti
- Urology, ASL 3 Napoli Castellammare di Stabia, Castellammare di Stabia, Italy
| | - Stefano Boccasile
- Department of Urology, Cima Barcelona Hospital, Barcelona, Catalogna, Spain
| | - Matteo Ferro
- Istituto Europeo di Oncologia, Milano, Lombardia, Italy
| | - Biagio Barone
- Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Napoli, Campania, Italy
| | - Antonio Celia
- Department of Urology, San Bassanino Hospital, Bassano del Grappa, Veneto, Italy
| |
Collapse
|
12
|
Chua KJ, Balraj V, Patel HV, Srivastava A, Doppalapudi SK, Elsamra SE, Jang TL, Singer EA, Ghodoussipour SB. Wound Complication Rates after Inguinal Lymph Node Dissection: Contemporary Analysis of the NSQIP Database. J Am Coll Surg 2023; 236:18-25. [PMID: 36519902 PMCID: PMC9764259 DOI: 10.1097/xcs.0000000000000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Inguinal lymph node dissection (ILND) is used for diagnosis and treatment in penile cancer (PC), vulvar cancer (VC), and melanomas draining to the inguinal lymph nodes. However, ILND is often characterized by its morbidity and high wound complication rate. Consequently, we aimed to characterize wound complication rates after ILND. STUDY DESIGN The NSQIP database was queried for ILND performed from 2005 to 2018 for melanoma, PC, or VC. Thirty-day wound complications included wound disruption and superficial, deep, and organ-space surgical site infection. Multivariable logistic regression was performed with covariates, including cancer type, age, American Society of Anesthesiologists score ≥3, BMI ≥30, smoking history, diabetes, operative time, and concomitant pelvic lymph node dissection. RESULTS A total of 1,099 patients had an ILND with 92, 115, and 892 ILNDs performed for PC, VC, and melanoma, respectively. Wound complications occurred in 161 (14.6%) patients, including 12 (13.0%), 17(14.8%), and 132 (14.8%) patients with PC, VC, and melanoma, respectively. Median length of stay was 1 day (interquartile range 0 to 3 days), and median operative time was 152 minutes (interquartile 83 to 192 minutes). Readmission rate was 12.7%. Wound complications were associated with longer operative time per 10 minutes (odds ratio 1.038, 95% CI 1.019 to 1.056, p < 0.001), BMI ≥30 (odds ratio 1.976, 95% CI 1.386 to 2.818, p < 0.001), and concomitant pelvic lymph node dissection (odds ratio 1.561, 95% CI 1.056 to 2.306, p = 0.025). CONCLUSIONS Predictors of wound complications after ILND include BMI ≥30, longer operative time, and concomitant pelvic lymph node dissection. There have been efforts to decrease ILND complication rates, including minimally invasive techniques and modified templates, which are not captured by NSQIP, and such approaches may be considered especially for those with increased complication risks.
Collapse
Affiliation(s)
- Kevin J Chua
- From the Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Dalkalitsis A, Salta S, Tsakiridis I, Dagklis T, Kalogiannidis I, Mamopoulos A, Daniilidis A, Athanasiadis A, Navrozoglou I, Paschopoulos M, Vatopoulou A, Kosmas I. Inguinal endometriosis: A systematic review. Taiwan J Obstet Gynecol 2022; 61:24-33. [PMID: 35181041 DOI: 10.1016/j.tjog.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/20/2022] Open
Abstract
Inguinal endometriosis is a very rare entity with uncertain pathophysiology, that poses several diagnostic and therapeutic challenges. This study aimed to summarize published literature on the diagnosis and treatment of this condition. Thus, a systematic literature search was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library. An effort was made to numerically analyze all parameters included in case reports and retrospective analyses, as well. The typical and atypical features of this condition, investigations used, type of treatment and histopathology were recorded. More specifications about the surgical treatment, such as operations previously performed, type of surgery and treatment after surgery have been acknowledged. Other sites of endometriosis, the presence of pelvic endometriosis and the follow-up and recurrence have been also documented. Overall, the search yielded 61 eligible studies including 133 cases of inguinal endometriosis. The typical clinical presentation includes a unilateral inguinal mass, with or without catamenial pain. Transabdominal or transvaginal ultrasound was typically used as the first line method of diagnosis. Groin incision and exploratory surgery was the treatment indicated by the majority of the authors, while excision of part of the round ligament was reported in about half of the cases. Chemotherapy and radiotherapy were initiated in cases of coexisting endometriosis-related neoplasia. Inguinal recurrence or malignant transformation was rarely reported. The treatment of inguinal endometriosis is surgical and a long-term follow-up is needed. More research is needed on the effectiveness of suppressive hormonal therapy, recurrence rate and its relationship with endometriosis-associated malignancies.
Collapse
Affiliation(s)
- Alexandros Dalkalitsis
- Department of Obstetrics and Gynecology, Genetics and IVF Unit, Medical School, Ioannina University, Ioannina, Greece
| | - Styliani Salta
- University Hospitals of Leicester, Haemophilia Centre, Leicester Royal Infirmary, Leicester, UK
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angelos Daniilidis
- Second Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Iordanis Navrozoglou
- Department of Obstetrics and Gynecology, Genetics and IVF Unit, Medical School, Ioannina University, Ioannina, Greece
| | - Minas Paschopoulos
- Department of Obstetrics and Gynecology, Genetics and IVF Unit, Medical School, Ioannina University, Ioannina, Greece
| | - Anastasia Vatopoulou
- Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Ioannina, Greece.
| |
Collapse
|
14
|
Azevedo RA, Roxo AC, Alvares SHB, Baptista DP, Favorito LA. Use of flaps in inguinal lymphadenectomy in metastatic penile cancer. Int Braz J Urol 2021; 47:1108-1119. [PMID: 34115457 PMCID: PMC8486440 DOI: 10.1590/s1677-5538.ibju.2021.99.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 05/20/2021] [Indexed: 04/04/2024] Open
Abstract
PURPOSE Reviewing surgical procedures using fasciocutaneous and myocutaneous flaps for inguinal reconstruction after lymphadenectomy in metastatic penile cancer. MATERIAL AND METHODS We reviewed the current literature of the Pubmed database according to PRISMA guidelines. The search terms used were "advanced penile cancer", "groin reconstruction", and "inguinal reconstruction", both alone and in combination. The bibliographic references used in the selected articles were also analyzed to include recent articles into our research. RESULTS A total of 54 studies were included in this review. About one third of penile cancers are diagnosed with locally advanced disease, often presenting with large lymph node involvement. Defects in the inguinal region resulting from the treatment of metastatic penile cancer are challenging for the surgeon and cause high patient morbidity, rendering primary closure unfeasible. Several fasciocutaneous and myocutaneous flaps of the abdomen and thigh can be used for the reconstruction of the inguinal region, transferring tissue to the affected area, and enabling tensionless closure. CONCLUSIONS The reconstruction of defects in the inguinal region with the aid of flaps allows for faster postoperative recovery and reduces the risk of complications. Thus, the patient will be able to undergo potential necessary adjuvant treatments sooner.
Collapse
Affiliation(s)
- Roberta Alvares Azevedo
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
- Universidade do Estado do Rio de JaneiroDepartamento de Cirurgia GeralRio de JaneiroRJBrasilDepartamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Ana Claudia Roxo
- Universidade do Estado do Rio de JaneiroDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Departamento de Cirurgia Geral, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| | - Silvia Helena Baima Alvares
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Daniel Pereira Baptista
- Hospital Mário KröeffDivisão de Cirurgia PlásticaRio de JaneiroRJBrasilDivisão de Cirurgia Plástica, Hospital Mário Kröeff, Rio de Janeiro, RJ, Brasil
| | - Luciano A. Favorito
- Universidade do Estado do Rio de JaneiroUnidade de Pesquisa UrogenitalRio de JaneiroRJBrasilUnidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro – UERJ, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
15
|
Shalaby R, Negm M, El-Sawaf M, Elsaied A, Shehata S, Hamed A, Shehata S, Radwan AB. Needlescopic Disconnection and Peritoneal Closure for Pediatric Inguinal Hernia Repair: A Novel Technique. Surg Laparosc Endosc Percutan Tech 2021; 32:272-278. [PMID: 34608108 DOI: 10.1097/sle.0000000000001001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are many laparoscopic techniques for pediatric congenital inguinal hernia repair. Needlescopic surgery was introduced recently in pediatric patients aiming at getting excellent cosmetic outcomes. PURPOSE The aim of this study was to describe a novel technique for needlescopic inguinal hernia repair in children. PATIENTS AND METHODS Needlescopic division of the hernial sac was carried out on 369 children in 6 pediatric tertiary centers during the period from August 2016 to May 2019. All hernias were repaired by a novel needlescopic procedure that replicates all the steps of the open herniotomy. RESULTS A total of 369 patients with 410 hernias were included in this study. They were 232 (62.9%) males and 137 (37.1%) females, with a mean age of 3.58±1.26 (range=2 to 8 y) and mean internal inguinal ring diameter was 13.65±3.85 mm (range=8 to 20 mm). The mean operative time was 23.36±4.67 minutes for bilateral and 14.28±2.98 minutes for unilateral cases. All cases were completed without conversion to conventional laparoscopy. All cases were followed up for a mean of 19.6±3.2 months. None of our patients developed recurrence or testicular atrophy and the scars were nearly invisible 3 months postoperatively. CONCLUSIONS Needlescopic pediatric inguinal hernia repair using disconnection of the hernia sac at internal inguinal ring with purse-string suture closure of peritoneum is feasible and safe with no recurrence and with outstanding cosmetic results.
Collapse
Affiliation(s)
- Rafik Shalaby
- Pediatric Surgery Department, Al-Azhar University Hospitals
| | - Mohamed Negm
- Pediatric Surgery Unit, South Valley University, Faculty of Medicine, Qena
| | | | - Adham Elsaied
- Pediatric Surgery Department, Mansoura University Children Hospital, Mansoura
| | - Sherif Shehata
- Pediatric Surgery Unit, Tanta University Hospitals, Tanta
| | - Ashraf Hamed
- Pediatric Surgery Department, Al-Azhar University Hospitals
| | - Sameh Shehata
- Pediatric Surgery Unit, Alexandria University hospital, Alexandria, Egypt
| | - Ahmed B Radwan
- Pediatric Surgery Department, Ain Shams University Hospitals, Cairo
| |
Collapse
|
16
|
Prządka P, Liszka B, Antończyk A, Skrzypczak P, Kiełbowicz Z, Patkowski D. Laparoscopic-assisted percutaneous herniorrhaphy as an alternative to open surgery technique in farm swines. PLoS One 2021; 16:e0256890. [PMID: 34479235 PMCID: PMC8416236 DOI: 10.1371/journal.pone.0256890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/17/2021] [Indexed: 12/04/2022] Open
Abstract
Background Despite numerous experimental studies presenting laparoscopic treatment of inguinal hernia in a pig model so far no described technique has been used in clinical patients of this species. Minimal invasiveness and the simplicity of closure of the inguinal canal using the Percutaneous Internal Ring Suturing (PIRS) technique makes it the world’s first technique for laparoscopic treatment of inguinal hernia in pigs as clinical patients. Aim This study aims to assess the applicability and effectiveness of the laparoscopic PIRS technique in the treatment of inguinal hernia in pigs as clinical patients and to compare the PIRS technique with the open surgery technique, which is currently being used. Methods The study was conducted on 22 non-castrated male pigs with inguinal hernia (clinical patients), divided into two equal groups: PIRS and open surgery (OS). In the PIRS group, the inner inguinal ring was closed with an optical trocar inserted at the umbilicus level and an injection needle with a suture material inserted percutaneously over the inguinal canal. The suture material was threaded through the inner inguinal ring and then tied, leaving the knot under the skin. As a result to this the inguinal canal was closed. In the OS group the procedure was performed with open access above the inguinal canal where, after dissection of the vaginal processus and reducing the contents of the hernia to the abdominal cavity, it was ligated as close to the inguinal canal as possible, and the wound was then closed in layers. Results All operated pigs returned to full fitness immediately after recovery from anesthesia. There was one case of hernia recurrence in the PIRS group. In the OS group all the operated pigs had a temporary swelling of the postoperative wound and the scrotum on the side of the operated inguinal hernia, which was not found in the PIRS group. Conclusions The effectiveness of the PIRS technique is comparable to that of open surgery. Considering the simplicity of the PIRS procedure and its minimal invasiveness, this technique may be used as an alternative to the open technique in the treatment of inguinal hernias in pigs not subjected to surgical castration.
Collapse
Affiliation(s)
- Przemysław Prządka
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
- * E-mail: ,
| | - Bartłomiej Liszka
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Agnieszka Antończyk
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Piotr Skrzypczak
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Zdzisław Kiełbowicz
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Dariusz Patkowski
- Department of Paediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland
| |
Collapse
|
17
|
Patel AS, Isharwal S. Single-port robotic inguinal lymph node dissection: A safe and feasible option for penile cancer. Surg Oncol 2021; 38:101633. [PMID: 34332496 DOI: 10.1016/j.suronc.2021.101633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/21/2021] [Accepted: 07/11/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Inguinal lymph node dissection (ILND) is essential to the accurate staging of advanced penile cancer and in determining prognosis. Open ILND is associated with significant morbidity. The robotic-assisted approach has been described with comparable nodal yield with the advantage of decreased postoperative complications when studied with the multiport robotic platform. This video shows our approach for an ILND with the Intuitive single port (SP) robotic platform. METHOD A 54-year-old man underwent a partial penectomy for a penile mass that revealed squamous cell carcinoma invading the corpus spongiosum (pT2). Patient had non-palpable lymph nodes on physical examination. We proceeded with the bilateral inguinal lymph node dissection using the Intuitive da Vinci Single-Port Robot. RESULTS A standard template dissection was performed on both sides. Due to nodal enlargement noted on the pre-operative CT scan on the right side, superficial and deep ILND were performed on that side. Intra-operative frozen section pathologies of superficial lymph nodes were negative on the left side. Bilateral saphenous veins were preserved. Total procedure time was 4 hours and 51 minutes in duration with minimal blood loss noted (<30 mL). Pathology revealed one 4.5cm superficial positive node on the right with no extra-nodal extension and no other positive nodes. No complications were noted. He was discharged on post-operative day 1 with minimal pain or leg swelling. CONCLUSIONS We describe the technique and feasibility of ILND using the SP robotic platform. This approach has the potential to reduce morbidity with comparable nodal dissection as the open approach.
Collapse
Affiliation(s)
- Amir S Patel
- Department of Urology, Oregon Health and Science University, Portland, OR, USA.
| | - Sudhir Isharwal
- Department of Urology, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
18
|
Griffin MA, Balsa IM, Mayhew PD. Bilateral intracorporeally sutured inguinal herniorrhaphy using 3-dimensional laparoscopy in a dog. Can Vet J 2021; 62:572-576. [PMID: 34219761 PMCID: PMC8118190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A 7-month-old, intact male, mixed breed dog with bilateral inguinal hernias underwent general anesthesia for laparoscopic bilateral inguinal herniorrhaphy via a 3-port approach. A 3-dimensional laparoscopic system was used to perform the procedure immediately following prescrotal open castration. Intracorporeal suturing with polypropylene was performed, and 2 cruciate sutures were placed to close each inguinal ring. The caudal aspect of each inguinal ring was left slightly open so as not to disrupt the passage or patency of vessels and nerves. No intra- or post-operative complications occurred. One year after surgery, the dog has no evidence of recurrence of the inguinal hernias. Key clinical message: This case report demonstrates a novel minimally invasive approach to inguinal herniorrhaphy in a dog with no reported complications and a good long-term outcome. Intracorporeally sutured inguinal herniorrhaphy is feasible in dogs with good results, although additional cases are needed to gain experience with this technique in dogs with varying presentations of inguinal hernias.
Collapse
Affiliation(s)
- Maureen A Griffin
- Department of Surgical and Radiological Sciences at the University of California-Davis, School of Veterinary Medicine, 1 Garrod Drive, Davis, California 95616, USA
| | - Ingrid M Balsa
- Department of Surgical and Radiological Sciences at the University of California-Davis, School of Veterinary Medicine, 1 Garrod Drive, Davis, California 95616, USA
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences at the University of California-Davis, School of Veterinary Medicine, 1 Garrod Drive, Davis, California 95616, USA
| |
Collapse
|
19
|
Cirocchi R, Sutera M, Fedeli P, Anania G, Covarelli P, Suadoni F, Boselli C, Carlini L, Trastulli S, D'Andrea V, Bruzzone P. Authors' Reply: Ilioinguinal Nerve Neurectomy is better than Preservation in Lichtenstein Hernia Repair: A Systematic Literature Review and Meta-analysis. World J Surg 2021; 45:2631-2632. [PMID: 34031712 DOI: 10.1007/s00268-021-06167-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
- Inguinal Nerve Working Group, Perugia, Italy.
| | - Marco Sutera
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Inguinal Nerve Working Group, Perugia, Italy
| | - Piergiorgio Fedeli
- Inguinal Nerve Working Group, Perugia, Italy
- Department of Surgery, University of Ferrara, Ferrara, Italy
| | - Gabriele Anania
- Institute of Legal Medicine, University of Camerino, Camerino, Italy
| | - Piero Covarelli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabio Suadoni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Carlo Boselli
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Inguinal Nerve Working Group, Perugia, Italy
| | - Luigi Carlini
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Vito D'Andrea
- Inguinal Nerve Working Group, Perugia, Italy
- Department of Surgical Science, Sapienza Università di Roma, Rome, Italy
| | - Paolo Bruzzone
- Inguinal Nerve Working Group, Perugia, Italy
- Dipartimento Di Chirurgia Generale E Specialistica "Paride Stefanini", Sapienza Università di Roma, Rome, Italy
| |
Collapse
|
20
|
Abstract
RATIONALE We report a case with inguinal subcutaneous endometriosis without typical cyclic dysmenorrhea and accompanied with a hernia sac treated with resection of the tumor and herniorrhaphy. PATIENT CONCERNS A 40-year-old woman had a painless enlarged inguinal nodule for 3 months. DIAGNOSES Subcutaneous endometriosis accompanied with a hernia sac. INTERVENTIONS Ultrasonography showed a hypoechoic lesion (3.0 cm × 2.0 cm), and an inguinal subcutaneous tumor was first suspected. After surgical exploration, a cystic lesion was excised and the hernia hole was repaired by herniorrhaphy. The immunohistochemical analysis of the small endometriotic cyst-like lesion revealed calretinin (-) in epithelial cells and CD10 (+) in stromal cells, indicative of subcutaneous endometriosis accompanied with a hernia sac. OUTCOMES The patient was followed up for 1 year and without recurrence. LESSONS Cutaneous endometriosis accompanied with a hernia sac can be presented without typical endometriosis-associated symptoms such as dysmenorrhea. Inguinal endometriosis might be the differential diagnosis of inguinal painless nodules.
Collapse
Affiliation(s)
| | - Chiu-Hsuan Cheng
- Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
21
|
Frýbová B, Trčka J, Dotlačil V, Poš L, Patkowski D, Rygl M. Laparoscopic inguinal hernia repair in children via PIRS (percutaneous internal ring suturing). Rozhl Chir 2020; 99:277-281. [PMID: 32736483 DOI: 10.33699/pis.2020.99.6.277-281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The miniinvasive approach is a trend in pediatric surgery nowadays. The new surgical technique called percutaneous internal ring suturing (PIRS) is a promising method bringing all the benefits of miniinvasive surgery. METHODS Prospective study of patients operated on using the PIRS technique from 01 January 2018 to 01 January 2020 at the Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University, University Hospital Motol. RESULTS 73 patients (25 boys and 48 girls) were operated on using PIRS. The median age was 68 months. 90 % of operations were performed by the same team of surgeons. During the procedure there were found 53 right-sided and 38 left-sided inguinal hernias. In 18 cases the hernia was bilateral, but only in 13 cases was this diagnosis made before the operation. A non-absorbable stitch was used in 57 cases to close the internal ring of the inguinal canal, and a non-absorbable monofilament in 16. The median operating time was 34 minutes. There were 3 recurrences (3.3 %) in our study. Conclusion: In our initial study, the PIRS technique proved to be a safe alternative method to the open inguinal hernia surgery. This method provides the benefit of allowing to revise the contralateral inguinal canal as a prevention of a metachronous inguinal hernia. The cosmetic results were excellent.
Collapse
|
22
|
Prządka P, Liszka B, Skrzypczak P, Kubiak-Nowak D, Borawski W, Juźwiak Ł, Kiełbowicz Z, Patkowski D. Laparoscopic assisted percutaneous herniorrhapy in dogs using PIRS technique. PLoS One 2020; 15:e0235899. [PMID: 32649688 PMCID: PMC7351152 DOI: 10.1371/journal.pone.0235899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/25/2020] [Indexed: 11/19/2022] Open
Abstract
Background In the literature, no studies describe the use of laparoscopic techniques for inguinal hernia repair in canine clinical patients. The surgical technique—Percutaneous Internal Ring Suturing (PIRS) presented in this article is the world's first minimally invasive laparoscopic surgical technique for inguinal canal closure in dogs. Aim The aim of the presented study is to evaluate the possibility of employment of the laparoscopic PIRS technique in clinical practice as well as to technically evaluate its usefulness in the treatment of the inguinal hernia in dogs. The presented study describes the procedure and the results of laparoscopic treatment of 11 inguinal hernias in nine dogs (two bilateral). Methods The whole procedure is performed under camera control introduced through one umbilical trocar. The very closure of the inner inguinal ring is done with the injection needle by a small puncture over the inguinal canal with the help of which the suture material is inserted, and the canal of the operated inguinal hernia is closed. Each operated dog underwent a thorough clinical examination before surgery which was combined with ultrasound examination of the inguinal canals before, immediately after and three months after surgery. Results There was no hernia recurrence in the study period in the operated dogs and all individuals returned to full mobility immediately after recovery from anesthesia. Conclusions Due to the low invasiveness and simplicity of performance, the PIRS technique described in the study should be taken into account when choosing a treatment method for non-traumatic inguinal hernia in dogs. At the same time, the possibility of using the described technique in other types of inguinal hernia in dogs requires further research.
Collapse
Affiliation(s)
- Przemysław Prządka
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
- * E-mail: ,
| | - Bartłomiej Liszka
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Piotr Skrzypczak
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Dominika Kubiak-Nowak
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Wojciech Borawski
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Łukasz Juźwiak
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Zdzisław Kiełbowicz
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Dariusz Patkowski
- Department of Pediatric Surgery and Urology, Medical University of Wroclaw, Wroclaw, Poland
| |
Collapse
|
23
|
Prodromidou A, Machairas N, Garoufalia Z, Kostakis ID, Kyriakidis AV, Spartalis E, Sotiropoulos GC. Ovarian inguinal hernia. Ann R Coll Surg Engl 2020; 102:75-83. [PMID: 31696731 PMCID: PMC6996425 DOI: 10.1308/rcsann.2019.0137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Gynaecological structures such as the ovaries, fallopian tubes, ligaments and uterus are rarely encountered inside a hernial sac. The prevalence of groin hernias containing parts of female genitalia remains unknown. The aim of this review was to summarise the existing evidence on inguinal hernias containing ovaries with or without the other female adnexa. METHODS A systematic search was conducted for literature published up to February 2018 using the MEDLINE®, Scopus® and Google Scholar™ databases along with the references of the full-text articles retrieved. Papers on observational studies and case reports concerning women who were diagnosed with an ovarian inguinal hernia (pre or intraoperatively) were considered eligible for inclusion in the review. RESULTS Fifteen papers (13 case reports, 2 case series) comprising seventeen patients (mean age 47.9 years) were evaluated. A left-sided hernia was noted in 13 cases (77%) whereas 4 patients had a right-sided hernia. Eight patients underwent preoperative imaging with computed tomography, ultrasonography or both. This was diagnostic in five cases. In 11 patients, hernia contents were repositioned, 2 had a salpingo-oophorectomy and 2 an oophorectomy. Eight patients underwent hernia repair with mesh placement while three had a herniorrhaphy. CONCLUSIONS Ovarian inguinal hernias should be considered among the differential diagnoses of a groin mass or swelling. In women of reproductive age, repair of the hernia with the intent to preserve fertility is of critical importance.
Collapse
|
24
|
Muncie C, Cockrell H, Whitlock R, Morris M, Sawaya D. The Ideal Candidate for Subcutaneous Endoscopically Assisted Ligation (SEAL) of the Internal Ring for Pediatric Inguinal Hernia Repair. Am Surg 2019; 85:1262-1264. [PMID: 31775968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Subcutaneous endoscopically assisted ligation (SEAL) technique is an effective and minimally invasive approach for indirect inguinal hernia repair in children. Not all patients are candidates for SEAL because of technical limitations. We hypothesized that preoperatively assessed patient-level factors may predict technical feasibility of SEAL repair. We performed a retrospective review of all patients who underwent indirect inguinal hernia repair between June 2012 and December 2014. All patients younger than two years and any patient older than two years who had a concomitant umbilical hernia were considered candidates for diagnostic laparoscopy with SEAL repair. We compared patients who had SEAL repair with those who had diagnostic laparoscopy with conversion to open repair. Univariate statistics was performed using the chi-squared and Student's t test. One hundred forty-one patients underwent diagnostic laparoscopy with intent to perform a SEAL repair. Seventeen patients were lost to follow-up. Of the remaining 124 patients, 66 had SEAL repairs, 35 had open repairs, and 23 had a SEAL repair with contralateral open repair. Patient age, BMI, gender, history of prematurity, and history of incarcerated hernia were similar between the SEAL and open groups. Sixty-two per cent of hernias were able to be repaired with SEAL technique. Hernia recurrence was seen in 3 of 123 total SEAL repairs and in 1 of 74 open repairs. The recurrence rate for SEAL repairs (2.4%) was not significantly different from the recurrence rate for open repairs (1.4%). No preoperative patient-level factors predicted technical inability to perform a successful SEAL repair. In this series, the recurrence risk of SEAL compared with open repair was low and not statistically significant. For practitioners with minimally invasive experience, SEAL should be considered a safe and successful option for inguinal hernia repair in pediatric patients undergoing routine diagnostic laparoscopy.
Collapse
|
25
|
Álvarez García N, López Galera S, Núñez García B, Esteva Miró C, Pérez Gaspar M, Betancourth Alvarenga JE, Santiago Martínez S, Brun Lozano N, Izquierdo Guerrero A. [Caudal regional anesthesia: a safe anesthetic procedure for abdominal and inguinal surgery in newborns and toddlers]. Cir Pediatr 2019; 32:181-184. [PMID: 31626402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Caudal anesthesia is a safe and effective technique in children. Some surgical procedures, such as abdominal or inguinal surgeries, could be performed avoiding general anesthesia in newborns and babies, reducing the risk of respiratory depression and neurotoxicity. Our objective is to analyze the experience in a tertial referral center. MATERIAL AND METHODS We carried a retrospective study in patients under 1 year of age who underwent abdominal or inguinal procedures under caudal regional anesthesia, between 2016 and 2018. Demographics, diagnosis, comorbidity, surgical procedure, operation time, oral intake, perioperative complications and hospital stay were recorded. RESULTS We included 87 patients under 1 year of age. In 56 patients (23 males, 33 females) surgery was performed under caudal anesthesia (37 scheduled, 19 urgent). Mean age was 2 months (0-11). Comorbidity: 25 associated prematurity, 3 severe tracheomalacia, 1 apnea and 8 bronchopulmonary dysplasia. Surgical procedures: 34 inguinal hernia repair, 9 incarcerated inguinal hernias, 5 neonatal testicular torsions, 8 pyloromyotomies. Mean operation time was 35 min (15-80) and mean anesthetic time 30 min (20-60). Oral intake started 2 h after surgery in 55 patients. Discharge was given in 24 h (12-36). Complications were not noticed. Any patient needed conversion to general anesthesia. CONCLUSIONS Caudal anesthesia should be the anesthetic technique of choice in newborns and babies who undergo abdominal or inguinal surgeries, especially in those with comorbidity. This procedure could be performed safely, avoiding respiratory or neurological complications, with a fast recovery of patients and short hospital stay.
Collapse
Affiliation(s)
- N Álvarez García
- Médico Adjunto Servicio de Cirugía Pediátrica. Corporación Sanitaria Parc Taulí. Sabadell (Barcelona)
| | - S López Galera
- Jefe de Unidad de Anestesia Pediátrica. Corporación Sanitaria Parc Taulí. Sabadell (Barcelona)
| | - B Núñez García
- Jefe de Servicio Cirugía Pediátrica. Corporación Sanitaria Parc Taulí. Sabadell (Barcelona)
| | - C Esteva Miró
- MIR Servicio de Cirugía Pediátrica. Corporación Sanitaria Parc Taulí. Sabadell (Barcelona)
| | - M Pérez Gaspar
- MIR Servicio de Cirugía Pediátrica. Corporación Sanitaria Parc Taulí. Sabadell (Barcelona)
| | - J E Betancourth Alvarenga
- Médico Adjunto Servicio de Cirugía Pediátrica. Corporación Sanitaria Parc Taulí. Sabadell (Barcelona)
| | - S Santiago Martínez
- Médico Adjunto Servicio de Cirugía Pediátrica. Corporación Sanitaria Parc Taulí. Sabadell (Barcelona)
| | - N Brun Lozano
- Médico Adjunto Servicio de Cirugía Pediátrica. Corporación Sanitaria Parc Taulí. Sabadell (Barcelona)
| | - A Izquierdo Guerrero
- Médico Adjunto Servicio Anestesia.Corporación Sanitaria Parc Taulí. Sabadell (Barcelona)
| |
Collapse
|
26
|
Leng Q, Li BK, Mao XM. [Video endosopic inguinal lymphadenectomy for penile cancer]. Zhonghua Nan Ke Xue 2019; 25:848-851. [PMID: 32233215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Inguinal lymph node metastasis is one of the important factors affecting the prognosis of penile cancer. Conventional open inguinal lymphadenectomy, with a high rate of complications, seriously affects the effect of surgery and the patient's quality of life, and therefore is rarely employed nowadays as a treatment option. Video endosopic inguinal lymphadenectomy (VEIL), however, can significantly reduce the incidence rate of surgery-related complications, achieve a desirable control of the tumor, and markedly improve the prognosis. This review focuses on the application, development, indications, effectiveness and complications of VEIL in the treatment of penile cancer.
Collapse
Affiliation(s)
- Qu Leng
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Bing-Kun Li
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, China
| | - Xiang-Ming Mao
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong 510280, China
| |
Collapse
|
27
|
Abstract
Aim and Background Tumor appearing in an inguinal hernia sac indicates widespread carcinomatosis with ascites. A new onset hernia is a common clinical presentation of pseudomyxoma peritonei syndrome arising in an appendiceal mucinous tumor. Recurrence of pseudomyxoma peritonei within the inguinal region was previously reported in only a single patient. We present five patients with a recurrence of pseudomyxoma peritonei tumor nodules in the inguinal region following cytoreductive surgery and attempt to understand the etiology of this treatment failure. Methods and Study Design From a database of 910 patients with mucinous appendiceal tumors with peritoneal dissemination who had definitive treatment, five patients who had disease recurrence within the inguinal region were identified. The clinical histories were studied and presented in order to make future recommendations regarding the management of these patients. Results Five patients with ages ranging 39 to 67 years had a mucinous tumor in the inguinal region as a recurrence after a previous cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. One of them had separate recurrence in both right and left inguinal regions. All these patients were made disease-free by the reoperative surgery with a sacrifice of the testicle in four. None have evidence of a recurrence of an inguinal hernia despite the lack of formal repair. Conclusion At the time of initial cytoreductive surgery the surgeon should be aware of the inguinal region as a possible site of relapse. This may be more problematic in patients who have had prior surgery with mucoid fluid in a hernia as the presenting sign of pseudomyxoma peritonei. Inguinal recurrences should be removed with clear margins even if orchiectomy is required.
Collapse
|
28
|
Hu J, Li H, Cui Y, Liu P, Zhou X, Liu L, Chen H, Chen J, Zu X. Comparison of clinical feasibility and oncological outcomes between video endoscopic and open inguinal lymphadenectomy for penile cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15862. [PMID: 31145338 PMCID: PMC6708994 DOI: 10.1097/md.0000000000015862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To compare the clinical feasibility and oncological outcomes of video endoscopic inguinal lymph node dissection (VE-ILND) and open inguinal lymph node dissection (O-ILND) in the management of penile cancer. METHODS We searched published articles in the PubMed, Embase, Cochrane Library, Web of science, China National Knowledge Infrastructure, and Wanfang databases. Data were extracted by 2 independent authors, and meta-analysis was performed by using Review Manager software version 5.3. RESULTS Ten studies were included. Compared with the O-ILND group, the VE-ILND group exhibited less intraoperative blood loss (standardized mean difference [SMD] = 3.12; 95% confidence intervals [95% CIs] [1.27, 4.98]; P = .001), shorter hospital stay (SMD = 1.77; 95% CIs [0.94, 2.60]; P < .001), shorter drainage time (SMD = 2.69; 95% CI [1.47, 3.91]; P < .001), reduced wound infection rate (odds ratio [OR] = 10.62; 95% CI [4.01, 28.10]; P < .001); reduced skin necrosis rate (OR = 7.48; 95% CI [2.79, 20.05]; P < .001), lower lymphedema rate (OR = 3.23; 95% CI [1.51, 6.88]; P = .002), equivalent lymphocele rate (OR = 0.83; 95% CI [0.31, 2.23]; P = .720), and parallel recurrence rate (OR = 1.54; 95% CI [0.41, 5.84]; P = 0.530). However, the number of dissected lymph nodes (OR = 0.25; 95% CI [0.03, 0.47]; P = .030) was slightly increased in the O-ILND group. GRADE recommendations of primary outcomes were shown in a summary of findings table. CONCLUSIONS For perioperative outcomes, VE-ILND is superior to O-ILND. For short-term oncological outcomes, VE-ILND is comparable to O-ILND. However, long-term oncological control still requires further verification.
Collapse
Affiliation(s)
| | | | | | | | - Xu Zhou
- Reproductive Medicine Center, Xiangya Hospital, Central South University, Changsha, China
| | | | | | | | | |
Collapse
|
29
|
Sánchez-García A, García Moreno MÁ, Salmerón-González E, García-Vilariño E, Valverde-Navarro AA. Inguinal Reconstruction Using Pedicled Rectus Abdominis Flap: A Useful Option for the Application of Radiotherapy. Plast Surg Nurs 2019; 39:41-43. [PMID: 31136556 DOI: 10.1097/psn.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Given their high rate of complications, radical surgical procedures of anorectal and gynecological tumors require a reliable and individualized reconstruction. The latter is influenced by the frequent indication of adjuvant chemo/radiotherapy that they present. We describe the case of a patient with medical history of vulvar carcinoma that required radical surgery and bilateral inguinal lymphadenectomy. Because of the stage of the tumor, the application of postoperative radiotherapy was clinically indicated; however, after surgery, the patient developed bilateral inguinal ulcers that made postoperative radiotherapy application impossible. Using a radical surgical approach in combination with postoperative radiotherapy increases survival in patients with these types of tumors. Therefore, delaying its use because of wound complications or inadequate reconstruction cannot be justified. The pedicled abdominal rectus flap is an excellent option for this purpose in patients with moderate- to large-sized defects.
Collapse
Affiliation(s)
- Alberto Sánchez-García
- Alberto Sánchez-García, MD, is at Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe, Valencia, Spain. Miguel Ángel García Moreno, MD, is at Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe, Valencia, Spain. Enrique Salmerón-González, MD, is at Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe, Valencia, Spain. Elena García-Vilariño, MD, is at Plastic and Reconstructive Surgery Department, University and Polytechnic Hospital La Fe, Valencia, Spain. Alfonso A. Valverde-Navarro, PhD, is at Department of Human Anatomy and Embriology, University of Valencia, Valencia, Spain
| | | | | | | | | |
Collapse
|
30
|
Hyde GA, Jung NL, Valle AA, Bhattacharya SD, Keel CE. Robotic inguinal lymph node dissection for melanoma: a novel approach to a complicated problem. J Robot Surg 2018; 12:745-748. [PMID: 29307097 DOI: 10.1007/s11701-017-0776-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Indications for superficial inguinal lymph node (ILN) dissection in melanoma include fine needle aspiration or clinically positive ILN and sentinel lymph nodes (SLN). Open inguinal lymphadenectomy may be complicated by poor wound healing, deep vein thrombosis, and lymphedema. Technical considerations and case series of a novel surgical approach, robotic inguinal lymphadenectomy, are presented. METHODS This is a case series of four robotic ILN dissections for melanoma at a tertiary care facility. Each patient had previously diagnosed melanoma by lymph node biopsy. Physician and patient jointly decided on robotic procedure after disclosure of this novel approach. Demographic, complication, pathological outcome, estimated blood loss (EBL), operative time, and length of stay (LOS) data were collected. RESULTS No cases were aborted due to technical difficulty. The median patient age was 44.5 years (range 22-53 years) and median BMI was 27.5 (range 20.4-40.2). Operative time range was 120-231 min and EBL from 0 to 100 mL. Median nodal count was 5.5 (range 1-14 nodes). Patient LOS ranged from 0 (discharged from post anesthesia care unit) to 96 h. There was one complication of port site cellulitis, one seroma formation, and no instances of lymphedema. To date, there have been no deaths or melanoma recurrences in this population. CONCLUSION Recent data suggest a minimum node count of six to seven for inguinal dissection. Of our four dissections, two were above this threshold and there were minimal postoperative complications. Given our limited sample size, future focus should be on increasing the data on this approach to optimize surgical outcomes and oncologic results.
Collapse
Affiliation(s)
- G Alan Hyde
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA.
| | - Nathan L Jung
- Department of Urology, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite C-925, Chattanooga, TN, 37403, USA
| | - Alvaro A Valle
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - Syamal D Bhattacharya
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite B-401, Chattanooga, TN, 37403, USA
| | - Christopher E Keel
- Department of Urology, University of Tennessee College of Medicine Chattanooga, 979 East Third Street, Suite C-925, Chattanooga, TN, 37403, USA
| |
Collapse
|
31
|
de la Vega M, Townsend KL, Terry J, Nemanic S. Urinary bladder herniation through inguinal ring in a female cat. Can Vet J 2018; 59:1085-1088. [PMID: 30510313 PMCID: PMC6135267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 7-month-old spayed female domestic shorthair cat was referred for lethargy, stranguria, and a fluctuant mass of varying size in the right inguinal region. Computed tomographic imaging revealed the urinary bladder partially herniated through the right inguinal canal. Primary herniorrhaphy was performed and re-placement of the urinary bladder was confirmed via laparotomy.
Collapse
Affiliation(s)
- Miranda de la Vega
- Department of Clinical Sciences, Oregon State University, 172 Magruder Hall, Corvallis, Oregon 97331, USA
| | - Katy L Townsend
- Department of Clinical Sciences, Oregon State University, 172 Magruder Hall, Corvallis, Oregon 97331, USA
| | - Jesse Terry
- Department of Clinical Sciences, Oregon State University, 172 Magruder Hall, Corvallis, Oregon 97331, USA
| | - Sarah Nemanic
- Department of Clinical Sciences, Oregon State University, 172 Magruder Hall, Corvallis, Oregon 97331, USA
| |
Collapse
|
32
|
Wolfhagen N, Simons NE, de Jong KH, van Kesteren PJM, Simons MP. Inguinal endometriosis, a rare entity of which surgeons should be aware: clinical aspects and long-term follow-up of nine cases. Hernia 2018; 22:881-886. [PMID: 30078093 DOI: 10.1007/s10029-018-1797-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Inguinal endometriosis is a rare disease and often misdiagnosed for other, more common groin pathology. We present nine cases of women with inguinal endometriosis with long-term follow-up. METHODS In this retrospective case series, the Dutch PALGA system was searched for all patients diagnosed with extrapelvic endometriosis located in the groin in the OLVG hospital, Amsterdam, between 2000 and 2016. Relevant information regarding pre- and postoperative characteristics and symptoms was collected. Follow-up consisted of a telephone call from the attending surgeon. RESULTS None of the patients had a history of pelvic endometriosis. Typically, they presented with a right-sided swelling in the groin. Preoperative ultrasound and MRI were in most cases inconclusive. In one of two patients fna indicated endometriosis. In only three patients the surgeon considered the diagnosis endometriosis preoperatively. Surgical removal was effective with no reported complications. A coexisting hernia sac was resected in four cases, and there was a suspicion of a persistent processus vaginalis (canal of Nuck) in three, suggesting that a persistent processus vaginalis is possibly an important key to the pathogenesis. In none of the cases there was an indication for mesh implantation. One patient was later diagnosed with pelvic endometriosis. CONCLUSION Follow-up by a gynecologist is advised to check for intra-abdominal disease and inform patients on fertility perspective. Surgeons should be aware of the possibility of inguinal endometriosis in fertile women with a lump in the groin.
Collapse
Affiliation(s)
- N Wolfhagen
- Department of Surgery, Flevoziekenhuis, Almere, The Netherlands
| | - N E Simons
- Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands
| | - K H de Jong
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - P J M van Kesteren
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - M P Simons
- Department of Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands.
| |
Collapse
|
33
|
Sala P, Palmeri A, Costantini S. Giant cyst of the Nuck canal: a worrisome trouble for a girl. Am J Obstet Gynecol 2018; 218:530-531. [PMID: 29277632 DOI: 10.1016/j.ajog.2017.12.213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/14/2017] [Accepted: 12/16/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Paolo Sala
- Ospedale Policlinico San Martino, Genova, Italy
| | | | | |
Collapse
|
34
|
Perrone AM, Girolimetti G, Cima S, Kurelac I, Livi A, Caprara G, Santini D, Castellucci P, Morganti AG, Gasparre G, De Iaco P. Pathological and molecular diagnosis of bilateral inguinal lymph nodes metastases from low-grade endometrial adenocarcinoma: a case report with review of the literature. BMC Cancer 2018; 18:7. [PMID: 29295713 PMCID: PMC5751855 DOI: 10.1186/s12885-017-3944-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 12/20/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Extra-abdominal metastases in low grade endometrial carcinoma are rare events. Inguinal lymphatic spread occurs usually in advanced disease and is associated with abdominal lymph nodes involvement. To our knowledge, isolated inguinal lymph node metastases in patients with early endometrial carcinoma have never been described thus far. CASE PRESENTATION We present an uncommon case of inguinal lymph node metastasis in a 51-year old patient with early endometrial disease without other metastatic involvement. The metastatic loci were analyzed with the recently validated method of mitochondrial DNA sequencing to demonstrate clonality of the lesions. CONCLUSIONS We describe the first case of inguinal metastasis from intramucous endometrial carcinoma; this case confirms the unpredictable spread of endometrial neoplasia and the importance of both patient's history and physical examination in good clinical practice.
Collapse
Affiliation(s)
| | - Giulia Girolimetti
- Department. Of Surgical and Medical Sciences (DIMEC), Medical Genetics Unit, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Simona Cima
- Radiotherapy Unit, Sant’Orsola-Malpighi hospital, Bologna, Italy
| | - Ivana Kurelac
- Department. Of Surgical and Medical Sciences (DIMEC), Medical Genetics Unit, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Alessandra Livi
- Oncologic Gynecology Unit, Sant’Orsola-Malpighi hospital, Bologna, Italy
| | - Giacomo Caprara
- Pathology Unit, Sant’Orsola-Malpighi hospital, Bologna, Italy
| | | | - Paolo Castellucci
- Nuclear Medicine Unit, Sant’Orsola-Malpighi hospital, Bologna, Italy
| | | | - Giuseppe Gasparre
- Department. Of Surgical and Medical Sciences (DIMEC), Medical Genetics Unit, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Pierandrea De Iaco
- Oncologic Gynecology Unit, Sant’Orsola-Malpighi hospital, Bologna, Italy
| |
Collapse
|
35
|
Landry M, Lewis J. Comparison of Outcomes between Open versus Videoscopic Superficial Inguinal Lymph Node Dissection. Am Surg 2017; 83:e332-e334. [PMID: 28822379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
36
|
Wu K, Yan G, Yin W, Chen X, Wang G, Cheng Y. A Novel Approach of Microscopic Subinguinal Varicocelectomy With a "Pulling" Strategy. Urology 2016; 104:97-101. [PMID: 28042049 DOI: 10.1016/j.urology.2016.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/13/2016] [Accepted: 12/20/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of a novel approach of microscopic subinguinal varicocelectomy with a "pulling" strategy. MATERIALS AND METHODS Fifty-two male patients with varicocele were enrolled in this study. Twenty-six patients underwent conventional microscopic subinguinal varicocelectomy, whereas the remaining 26 patients accepted our novel approach of treatment. In this method, with a subinguinal incision, we dissociated the spermatic cord from the external ring. And thus we pulled the spermatic cord down and away from the external ring and exposed the spermatic cord that initially was proximal to the external ring in the surgical field. The remainder of the procedure was similar to that of the conventional method. Follow-up was made at 1 and 3 months. Postoperative complications were recorded and sperm parameters were evaluated by semen analysis. RESULTS Fewer vein branches were ligated in the novel method group compared with the conventional method group (6.9 ± 2.1 vs 9.8 ± 2.2, P < .001; t = -5.316). There was no significant difference in the number of testicular arteries or lymphatic ducts between the 2 groups. The mean microsurgical operative time in the novel method group was significantly shorter than that in the conventional method group (34.7 ± 6.5 minutes vs 45.7 ± 8.8 minutes, P < .001; t = -5.621). The incidence of postoperative complications was similar for the 2 groups. There was no significant difference regarding semen quality improvement between the 2 groups. CONCLUSION This study demonstrates that our novel approach of microscopic subinguinal varicocelectomy with a "pulling" strategy significantly reduces the number of internal veins to ligate and shortens operating time, with no increase in complications. It is a safe and effective method of varicocele treatment.
Collapse
Affiliation(s)
- Kerong Wu
- Department of Urology, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China; Department of Urology, First Affiliated Hospital, Soochow University, Suzhou, Jiangsu, China
| | - Guang Yan
- Soochow University, Suzhou, Jiangsu, China
| | - Weiqi Yin
- Department of Urology, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Xueqin Chen
- Department of Reproductive Medicine, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Guoyao Wang
- Department of Urology, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China
| | - Yue Cheng
- Department of Urology, Zhejiang University Ningbo Hospital, Ningbo First Hospital, Ningbo, Zhejiang, China.
| |
Collapse
|
37
|
Abstract
Hydrocele in the Canal of Nuck is a condition of female fetal development. The Canal of Nuck is a patent tubular peritoneal fold that travels with the round ligament to its attachment on the labia major. Failure of complete obliteration of the Canal of Nuck during fetal development predisposes females to development of a hydrocele or an inguinal hernia during post-pubertal or adult stages. We present a case of a 21 year old female with a tender reducible labial mass diagnosed as a Hydrocele in the Canal of Nuck.
Collapse
Affiliation(s)
- Varun Sethi
- Department of Radiology, Temple University, Philadelphia, USA
| | - Harshad Patel
- Department of Radiology, Temple University, Philadelphia, USA
| |
Collapse
|
38
|
Affiliation(s)
- Vassilios Mouravas
- Second Department of Pediatric Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Sfoungaris
- First Department of Pediatric Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| |
Collapse
|
39
|
Thomas DT, Göcmen KB, Tulgar S, Boga I. Percutaneous internal ring suturing is a safe and effective method for the minimal invasive treatment of pediatric inguinal hernia: Experience with 250 cases. J Pediatr Surg 2016; 51:1330-5. [PMID: 26777889 DOI: 10.1016/j.jpedsurg.2015.11.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/04/2015] [Accepted: 11/29/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND/PURPOSE Percutaneous internal ring suturing (PIRS) is a minimally invasive method for repair of pediatric inguinal hernia. In this study we report our experience with PIRS. METHODS All children >10kg presenting to our institute between June 2013 and March 2015 with a diagnosis of indirect inguinal hernia or communicating hydrocele underwent laparoscopic repair using PIRS technique. Patients' gender, age at surgery, side of inguinal hernia/communicating hydrocele at diagnosis, peroperative findings, surgical and anesthesia times plus follow-up findings were collected. RESULTS Two-hundred thirteen patients underwent 250 procedures. Inguinal hernia or communicating hydrocele was diagnosed on the right side in 113 (53.1%), the left side in 75 (35.2%) and bilaterally in 25 patients (11.7%). Contralateral hernia was found in 35 patients (16.4%). Mean surgery time was 14.3min for unilateral and 20.4min for bilateral PIRS, and mean anesthesia time was 33.6min for unilateral and 39.1min for bilateral PIRS. Average follow-up time was 9.6months. Recurrence was seen in 3 (1.4%) and complications in 6 patients (2.8%). CONCLUSION PIRS is a simple, safe and effective method for the treatment of inguinal hernia and communicating hydrocele in children.
Collapse
Affiliation(s)
| | - Kamil Basar Göcmen
- Pendik State Hospital, Department of Pediatric Surgery, Istanbul, Turkey
| | - Serkan Tulgar
- Pendik State Hospital, Department of Anesthesiology & Reanimation, Istanbul, Turkey
| | - Ibrahim Boga
- Pendik State Hospital, Department of Anesthesiology & Reanimation, Istanbul, Turkey
| |
Collapse
|
40
|
Toshev S, Dimitrov I, Arabadzhiev A, Angelov K, Gribnev P, Sokolov M, Kanelova K, Shumarova S, Khayat N, Petrova N, Todorov G. [Inguinal endometriosis: two case reports and literature review]. Khirurgiia (Mosk) 2016; 82:129-133. [PMID: 29667790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Endometriosis is a common gynecological disease that is characterized by the presence of endometrial glands and stroma outside the uterus. Ectopic endometrial tissue can be localized in all organs of the human body, but it affects most often organs in the pelvis. The localization in the inguinal canal is extremely rare - 0.3% -0.6% of all cases of endometriosis. We report two cases of inguinal endometriosis in patients with a history of previous surgery in the pelvis. Both patients is formation in the inguinal region of increasing volume, accompanied by severe pain especially in the premenstrual period. The diagnosis was based on an exact medical history and histological examination. The main methods of treatment of inguinal endometriosis is radical surgical excision of the lesion. We recommend hormone therapy as an adjunct to treatment.
Collapse
|
41
|
Karnak İ, Haliloğlu M, Güçer Ş. Epidermal cyst in the patent processus vaginalis: An unusual inguinal mass in a girl. Turk J Pediatr 2015; 57:629-631. [PMID: 27735806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Epidermal cyst is a benign tumor that grows slowly and develops from entrapment of epidermis into the dermis. Inguinal canal is an extremely unusual location for an epidermal cyst in children. Here in, a 6-year-old girl presenting with inguinal mass which was diagnosed to be epidermal cyst in the patent processus vaginalis sac is reported. To the best of our knowledge, it is the first case of epidermal cyst in the patent processus vaginalis in a child.
Collapse
Affiliation(s)
- İbrahim Karnak
- Departments of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | | | | |
Collapse
|
42
|
Davies MG, El-Sayed HF. Objective performance goals after endovascular intervention for critical limb ischemia. J Vasc Surg 2015; 62:1555-63. [PMID: 26409847 DOI: 10.1016/j.jvs.2015.06.228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE During the last decade, primary endoluminal therapy for critical limb ischemia (CLI), assessed as rest pain and tissue loss of the lower extremity, has significantly increased. Reporting of patient-centered outcomes using the new Society for Vascular Surgery objective performance goals (OPGs) has been limited. This study examined the OPGs for infrainguinal endovascular management of CLI. METHODS A prospective database of patients undergoing endovascular treatment of the lower extremity for CLI between 2000 and 2011 was queried. Evaluated were clinical efficacy (absence of recurrent symptoms, maintenance of ambulation and absence of major amputation), amputation-free survival (survival without major amputation), and freedom from major adverse limb events (MALEs; above-ankle amputation of the index limb or major reintervention - new bypass graft, jump/interposition graft revision). RESULTS A total of 728 patients (60% male; age, 68 ± 14 years) underwent lower extremity interventions for CLI (66% tissue loss); of these, 39% had superficial femoral artery and tibial interventions. Diabetes mellitus was present in 71%, hyperlipidemia in 64%, and chronic renal insufficiency in 37%. Technical success was 96%. The overall rate at 30 days of major adverse cardiovascular events (MACEs) was 3% and MALEs was 12%. At 5 years, clinical efficacy was (mean ± standard error of the mean) 42% ± 5%, amputation-free survival was 41% ± 7%, and freedom from MALEs was 51% ± 4%. Clinical efficacy was significantly different in those presenting with rest pain and tissue loss and in the anatomic high-risk group compared with the clinical high-risk group, and both were worse compared with the group without clinical or high-risk criteria. CONCLUSIONS Endoluminal therapy for CLI is associated with early low MACE rates but high MALE rates. When the key outcome of amputation free survival is considered, predictors of a better outcome were absence of current smoking, a lower modified Edifoligide for the Prevention of Infrainguinal Vein Graft Failure (PREVENT III) amputation risk score, better preoperative ambulation status, lower MACEs, and discharge disposition to home. The presence of tissue loss and anatomic risk factors negatively affect outcomes. Longer-term outcomes after endovascular intervention for CLI remain relatively poor, with <40% success in objective performance outcomes at 5 years.
Collapse
Affiliation(s)
- Mark G Davies
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
| | - Hosam F El-Sayed
- Division of Vascular Diseases and Surgery, Department of Surgery, Ohio State University, Columbus, Ohio
| |
Collapse
|
43
|
Shaitelman SF, Cromwell KD, Rasmussen JC, Stout NL, Armer JM, Lasinski BB, Cormier JN. Recent progress in the treatment and prevention of cancer-related lymphedema. CA Cancer J Clin 2015; 65:55-81. [PMID: 25410402 PMCID: PMC4808814 DOI: 10.3322/caac.21253] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This article provides an overview of the recent developments in the diagnosis, treatment, and prevention of cancer-related lymphedema. Lymphedema incidence by tumor site is evaluated. Measurement techniques and trends in patient education and treatment are also summarized to include current trends in therapeutic and surgical treatment options as well as longer-term management. Finally, an overview of the policies related to insurance coverage and reimbursement will give the clinician an overview of important trends in the diagnosis, treatment, and management of cancer-related lymphedema.
Collapse
|
44
|
Mazzeo C, Gammeri E, Foti A, Rossitto M, Cucinotta E. Vulvar endometriosis and Nuck canal. Ann Ital Chir 2014; 85:S2239253X14023482. [PMID: 25707680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Endometriosis is not a well-known disease and sometimes its rare onset is a pathogenetic, diagnostic and therapeutic problem. The Canal of Nuck is an embryonal rest of the parietal peritoneum that accompanies the round ligament through the inguinal canal. The perviousness of the canal of Nuck could explain the pathogenesis of vulvar endometriosis. MATERIAL OF STUDY We reported a case of vulvar endometriosis localization, which is rather uncommon, in a patient previously operated on with cyst of Nuck. DISCUSSION One of the most helpful instrumental exams in defining the nature of vulvar swallows is magnetic resonance, but it remains difficult to diagnose vulvar endometriosis in spite of the instrumental exam in our possession. The hypothesis of retrograde menstruation is supported by the fact that ovarian localization is the most common in this disease. Extra-pelvic localization as well as vulvar one are less common. The Canal of Nuck is an embryonal rest of the parietal peritoneum that accompanies the round ligament through the inguinal canal. CONCLUSIONS Endometriosis could be taken into consideration in differential diagnosis of vulvar swellings, and for this reason it is necessary to carry out a histological exam in every operated vulvar neoformation. We suggest vaginalis-peritonei duct contamination as a possible pathogenesis mechanism of this disease.
Collapse
|
45
|
ten Brinke B, Klitsie PJ, Timman R, Busschbach JJV, Lange JF, Kleinrensink GJ. Anatomy education and classroom versus laparoscopic dissection-based training: a randomized study at one medical school. Acad Med 2014; 89:806-810. [PMID: 24667502 DOI: 10.1097/acm.0000000000000223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Anatomy education on embalmed specimens is presumed to have added educational value. However, although embalmed specimens have been used for anatomy education for years, there is little evidence on the added educational value of dissection-based teaching. The objective of this randomized study is to examine the added value of dissection-based teaching, using models of the inguinal region in embalmed specimens. METHOD In 2011, medical students at Erasmus Medical Center, The Netherlands, were randomly assigned to three groups. Group I attended lectures, group II attended dissection-based training using laparoscopic dissection models, and group III attended lectures as well as dissection-based laparoscopic training. To assess the improvement of anatomical knowledge, all students had to complete a practical test before, immediately after, and two weeks after training. Data were analyzed with mixed modeling. RESULTS Forty-six students participated in this study. No significant difference in results was observed among the three groups before the start of training. Immediately after the course, groups II and III scored significantly higher than group I (P < .001; P < .001), and group II scored higher than group III (P = .009). The difference between group I and groups II and III persisted during follow-up (P = 012; P = .001). The difference between groups II and III disappeared. CONCLUSIONS Three-dimensional anatomy education with dissection models enhances anatomy learning by medical students. Students who received dissection-based training scored higher in the short- and long term compared with students who did not receive this type of education.
Collapse
Affiliation(s)
- Bart ten Brinke
- Dr. ten Brinke is a researcher, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Dr. Klitsie is a PhD candidate, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Dr. Timman is a statistician, Department of Psychiatry, Section of Medical Psychology and Psychotherapy and Institute of Medical Education Research Rotterdam (iMERR), Rotterdam, The Netherlands. Dr. Busschbach is professor of psychology, Department of Psychiatry, Section of Medical Psychology and Psychotherapy and Institute of Medical Education Research, Rotterdam (iMERR), Rotterdam, The Netherlands. Dr. Lange is professor of surgery, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands. Dr. Kleinrensink is professor of anatomy, Department of Neuroscience and Anatomy, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
46
|
Uehara T, Takahashi S, Ichihara K, Hiyama Y, Hashimoto J, Kurimura Y, Masumori N. Surgical site infection of scrotal and inguinal lesions after urologic surgery. J Infect Chemother 2014; 20:186-9. [PMID: 24462435 DOI: 10.1016/j.jiac.2013.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/19/2022]
Abstract
To clarify the incidence of surgical site infection (SSI) after urological scrotal and inguinal surgical procedures and the preventive effect of antimicrobial prophylaxis for SSI, retrospective analysis was performed. The patients who underwent scrotal and inguinal operations from 2001 to 2010 were included in this analysis. A first or second generation cephalosporin was administered as antimicrobial prophylaxis just before the start of surgery and no additional prophylaxis was conducted. The surgery was classified into 76 (38%) cases with testicular sperm extraction (TESE), 72 (36%) with radical orchiectomy, 29 (14.5%) with bilateral orchiectomy (surgical castration) and 23 (11.5%) with other scrotal and inguinal operations. The median age and age range were 36 years and 18-81 years, respectively. SSI occurred in 7 (3.5%) cases. The frequencies of SSI were 6.5% in the patients with urological inguinal surgery and 1.6% in those with scrotal surgery. The frequency of SSI in the patients with urological inguinal surgery was not negligible even though it is considered a clean operation, and further analysis is warranted to prevent SSI.
Collapse
Affiliation(s)
- Teruhisa Uehara
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Takahashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan.
| | - Kohji Ichihara
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Jiro Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuichiro Kurimura
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
47
|
Vasyliuk SM, Prudnikov OV. [The choice of hernioplasty method in elderly and senile patients with noncomplicated inguinal hernia]. Klin Khir 2014:12-15. [PMID: 24923141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Complex examination and surgical treatment was performed in 220 elderly and senile patients for various types of inguinal hernia (IH) in accordance to Nyhus classification. In 103 patients (the main group) hernioplasty was performed according to Lichtenstein method or using modifications, proposed by us; in 117 (the comparison group)--the tension hernioplasty, using the patient's tissues. According to data of morphological investigation of the inguinal channel musculo-aponeurotic structures in 24 patients there was established, that in the oblique IH formation a biochemical instability of the connective tissue structures plays a leading role, while in a direct type of IH--the reduction of muscular fibrils quantity, lowering their elasticity and a contractile answer velocity. Application of a tension-free methods of plasty in elderly and senile patients is pathogenetically substantiated, it permits to reduce the hospital stay, the physical rehabilitation duration, the complications and recurrences rate, and to improve quality of life in remote follow-up period after operative intervention.
Collapse
|
48
|
Jonkov A, Todorov R, Katibova S, Dimitrova V. Clinical case of a patient diagnosed with sinister inguinal hernia and disembriogenesis of the inguinal canal. Khirurgiia (Mosk) 2014:90-95. [PMID: 25417274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hernia (lat. - rupture, burst) or protrusion represents the act of escape of tissue, organ or an organ constituent through an innate or acquired fault of the muscle or the connective tissue membrane. The inguinal hernia, also known as groin hernia, rates one of the most frequent surgical conditions. It is manifested by all ages, however is more common in males. The inguinal hernia exhibits by the protrusion of abdominal organs or their segments, for instance portions of the small or large intestine, into the inguinal canal. The groin hernias classify into two subtypes--direct and indirect, and also acquired and inherited. Two kind of anomalies exist--anomalies connected with the obliteration of processus vaginalis peritonei and anomalies connected with the embryogenessis of the inguinal canal. We present a clinical case of a 59-years-old male presenting with emerged arch-like protuberance in the sinister groin region, enlarging during physical effort and strain, accompanied by a strong, harsh pain. Intraoperatively it was discovered a disembryogenessis of the inguinal canal, a total lack of the front wall of the canal itself, a lack of formed superficial inguinal opening and inobliterated processus vaginalis peritonei.
Collapse
|
49
|
Ignat'ev RO, Bataev SM, Bogdanov SE, Oznobishin VN. [Laparoscopic herniorrhaphy in children]. Khirurgiia (Mosk) 2014:30-35. [PMID: 25042188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
It was described the results of endosurgical treatment different technique of 170 children of both sexes aged 4 months to 14 years. Children had inguinal hernia. There were unilateral hernia in 148 patients and bilateral hernia in 22 patients. It was used such interventions as laparoscopic herniotomy with hernial sac extirpation (6 operations), laparoscopic suturing of deep inguinal ring (22 operations), dual-port laparoscopic extraperitoneal herniorrhaphy (46 operations), original single-port laparoscopic extraperitoneal herniorrhaphy (118 operations). The minimum duration of the operation (4.5-7.5 minutes) was observed in the last group. These patients did not need postoperative anesthesia. Relapse was detected in 2 (1.1%) cases. Developed single-port laparoscopic extraperitoneal herniorrhaphy may be alternative in children with inguinal hernia.
Collapse
|
50
|
Alp BF, Irkilata HC, Kibar Y, Zorba U, Sancaktutar AA, Kaya E, Dayanc M. Comparison of the inguinal and scrotal approaches for the treatment of communicating hydrocele in children. Kaohsiung J Med Sci 2013; 30:200-5. [PMID: 24656161 DOI: 10.1016/j.kjms.2013.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/09/2013] [Indexed: 11/19/2022] Open
Abstract
The inguinal approach is used for the treatment of hydrocele in the pediatric population. Although studies on scrotal orchiopexy have mentioned hernia or hydrocele repair through the same scrotal incision as a part of an orchiopexy procedure, there are a few studies reporting the treatment of isolated communicating hydrocele through a scrotal incision. We retrospectively evaluated and compared the outcomes of inguinal and scrotal approaches for the treatment of communicating hydrocele in boys. The classical inguinal and scrotal approaches to the treatment of communicating hydrocele were performed on 46 and 30 testicular units (in 43 boys and 27 boys, respectively). The patients' charts were reviewed to assess the operative times as well as the immediate and long-term complications during follow-up periods. The patients' ages ranged from 1 year to 8 years (3.6 ± 2.0 years) in the inguinal group and from 1 year to 10 years (mean 4.6 ± 2.8 years) in the scrotal group. Operative time was significantly lower in the scrotal group (p < 0.0001). The early minor complication rate did not differ between the two groups. Furthermore, there were no major complications noted. None of the patients had hydrocele recurrence after a mean follow-up of 6 months. The advantages of the scrotal approach for the treatment of communicating hydrocele are as follows: it is well tolerated, simple, and cosmetically appealing, and it has a short operative time in comparison with the standard inguinal approach. The scrotal incision technique is an effective alternative in communicating hydrocele treatment.
Collapse
Affiliation(s)
| | | | - Yusuf Kibar
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Unal Zorba
- School of Medicine, Rize University, Rize, Turkey
| | | | - Engin Kaya
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| | - Murat Dayanc
- Gulhane Military Medical Academy, Etlik, Ankara, Turkey
| |
Collapse
|