Background: Median arcuate ligament syndrome(MALS) is a rare condition thatmay cause significant clinical manifestations, including abdominal pain and weight loss. Its diagnosis may be difficult and very often delayed. The laparoscopic approach became the standard treatment of MALS. Aim: To assess the outcome of laparoscopic treatment in patients with MALS. Method: The data of sixpatients with MALS who were subjected to laparoscopic sectioning of the median arcuate ligament were retrospectively reviewed.The following data were evaluated: age, gender, clinical and diagnostic tests findings, ASA score, operative findings and complications, postoperative complications and mortality, hospital stay duration, and hospital readmission.The diagnosis of MALS was established by CT angiography and/or MR angiography. Results: There were four (66.7%) women and two (33.3%) men aged from 32 to 60 years. The main symptoms were epigastric pain (100%) and weight loss (66.7%). The findings of high-grade stenosis of the proximal celiac axis and poststenotic dilation confirmed on angiography confirmed the diagnosis in all patients. Surgical procedure was uneventful in all patients. The only postoperative complication was urinary retention that occurred in a male. At three-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic treatment of MALS is safe and effective in relieving the clinical manifestations of patients.

Background: Although the laparoscopic access is becoming the preferable treatment for femoral hernia, there are only few studies on this important subject. Aim: To assess the outcomes of the totally extraperitoneal laparoscopic (TEP) access in the treatment of femoral hernia. Methods: Data of 62 patients with femoral hernia who underwent herniorrhaphy were retrospectively reviewed. The diagnosis of femoral hernia was established by clinical and/or imaging exams in 55 patients and by laparoscopic findings in seven. Results: There were 55 (88.7%) females and 7 (11.3%) males, with female to male ratio of 8:1. The mean age was of 58.9±15.9 years, ranging from 22 to 92 years. Most patients (n=53; 85.5%) had single hernia and the remaining (n=9; 14.5%) bilateral, making a total of 71 hernias operated. Prior lower abdominal operations were recorded in 21 (33.9%) patients. Conversion to laparoscopic transabdominal preperitoneal procedure was performed in four (6.5%). Open herniorrhaphy was needed in two (3.2%), one with spontaneous enterocutaneous fistula in the groin region (Richter’s hernia) and the another with incidental perforation of the adjacent small bowel that occurred during dissection of hernia sac. There was no mortality. Conclusion: Femoral hernia is uncommon, and it may be associated with potentially severe complications. Most femoral hernias may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.

Background and Objectives: There is a dearth of studies on laparoscopic treatment of female groin hernia. Our study assessed the outcome of groin hernia repair in females employing the totally extraperitoneal laparoscopic (TEP) access.Methods: Data of all females who were subjected to laparoscopic groin herniorrhaphy, from August 1998 to February 2020 were retrospectively obtained. Groin hernia repair was routinely started with TEP access.Results: A total of 2,399 patients who underwent laparoscopic groin herniorrhaphy, 254 (10.6%), were females. Most females (n = 191; 75.2%) had single hernia and the remaining (n = 63; 24.8%) had bilateral hernias, making a total of 317 hernias operated. Indirect inguinal hernia was the most common hernia type (72.5%), followed by femoral hernia (17.4%) and direct hernia (10.1%). Prior lower abdominal operations were recorded in 97 (38.2%) patients. Conversion to a laparoscopic transabdominal preperitoneal procedure was performed due to technical difficulties to dissect the preperitoneal space in 17 patients (6.7%) and to open procedure in only one patient (0.4%) with incarcerated femoral hernia in whom an incidental perforation of the small bowel occurred. Intra-and postoperative complications occurred in 12 (4.7%) and 15 (5.9%) patients, respectively. There was no mortality. Most patients (n = 221; 87%) were discharged on the same day of the operation. Hernia recurrence was diagnosed in 6 patients (2.4%). Conclusion:It is concluded that females with groin hernia may be successfully treated with totally extraperitoneal laparoscopic access, with low conversion and complication rates.

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Instituição: SEDAVE Litíase urinária é uma afecção muito frequente em nosso meio. Após os anos 1980, o advento da endourologia transformou radicalmente o tratamento cirúrgico de cálculos urinários. O surgimento da Litotripsia Extracorpórea (LECO) e de procedimentos endoscópicos menos invasivos mudou o panorama antes constituído apenas por litotomias, caracterizadas por incisões cirúrgicas, piores resultados estéticos e convalescenças mais prolongadas e dolorosas. Assim, atualmente dispõe-se de várias alternativas para tratamento da litíase urinária. Por seu caráter menos invasivo LECO é a opção mais atraente para tratamento de cálculos renais e, na maioria dos casos, pode ser resolvida com esse método. Quando as características apontam para resultado ruim com LECO, NLP é uma opção interessante. As principais indicações de nefrolitotripsia percutânea são cálculos >20 mm ou coraliformes, cálculos em divertículos calicinais, cálculos em rim ferradura ou ectópicos, cálculos não resolvidos ou com contraindicação de LECO, cálculo calicinal inferior, cálculos grandes/impactados no ureter proximal. Após a punção e a passagem do fio-guia procede-se a dilatação do trajeto renocutâneo com uso de dilatadores faciais, metálicos ou com balão, a fim de colocar a bainha de Amplatz e introduzir o nefroscópio. NLP é a melhor opção de tratamento para cálculos coraliformes, conforme sugerido pelas diretrizes da AUA/2005. Relato de caso: GD, 54 anos, portador de litíase coraliforme à esquerda localizado em cálice superior, submetido a NLP dia 21/09/16, evoluiu no segundo dia pós-operatório com secreção fecalóide pelo orifício da nefrostomia, sem sinais de peritonismo. Devido à provável complicação de perfuração de cólon retroperitoneal foi optado por abordagem cirúrgica por lombotomia esquerda onde foi evidenciado pequena lesão na parede posterior do cólon descendente, sendo realizado colorrafia em dois planos e colocado dois drenos de Penrose. Paciente evoluiu com dor na ferida operatória, distensão abdominal e desconforto respiratório discretos no segundo dia pós-operatório, sem grandes achados em exames complementares, sendo optado por tratamento conservador. Iniciou-se dieta líquida no quarto dia pós-operatório, apresentando evacuações no quinto dia e recebendo alta no sexto dia com resolução do quadro. ABCDExpress 2017;1(2):359Codigo: 57802 Acesso está disponível em www.revistaabcd.com.br e www.sbad2017.com.br Acesso pelo

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