Giant pseudocyst is a rare complication of incisional hernia repairs whose etiology and incidence remains unknown. We have reviewed all cases of abdominal incisional hernia repair in our abdominal wall unit since its creation 6 years ago. Pseudocyst formation was observed in seven cases out of 871 incisional hernia repair operations. Four of them underwent surgical exploration with excision of the mass. To the best of our knowledge, only 18 cases of giant pseudocyst have been described in the literature. From both our personal experience and the reported literature, we understand that abdominal pseudocyst is an extremely rare or underreported late complication of hernia repair surgery. The complete excision of the cyst and its fibrous wall is the definitive treatment of choice.
Purpose The objective of this study was to gather information on patient-reported knowledge (PRK) in the field of hernia surgery. Methods A prospective quantitative study was designed to explore different aspects of PRK and opinions regarding hernia surgery. Patients referred for the first time to a surgical service with a presumed diagnosis of hernia and eventual hernia repair were eligible, and those who gave consent completed a simple self-assessment questionnaire before the clinical visit. Results The study population included 449 patients (72.8% men, mean age 61.5). Twenty (4.5%) patients did not have hernia on physical examination. The patient’s perceived health status was “neither bad nor good” or “good” in 56.6% of cases. Also, more patients considered that hernia repair would be an easy procedure (35.1%) rather than a difficult one (9.8%). Although patients were referred by their family physicians, 32 (7.1%) answered negatively to the question of coming to the visit to assess the presence of a hernia. The most important reason of the medical visit was to receive medical advice (77.7%), to be operated on as soon as possible (40.1%) or to be included in the surgical waiting list (35.9%). Also, 46.1% of the patients considered that they should undergo a hernia repair and 56.8% that surgery will be a definitive solution. Conclusion PRK of patients referred for the first time to an abdominal wall surgery unit with a presumed diagnosis of hernia was quite limited and there is still a long way towards improving knowledge of hernia surgery.
BackgroundRisk of choledocholithiasis should be assessed in every patient who must undergo cholecystectomy to define the next step. The American Gastroenterology Society (ASGE) proposed a stratified predictor scale of choledocholithiasis. MethodsTo describe our experience managing patients with intermediate risk of choledocholithiasis according to the ASGE guidelines and actual presence of bile duct stones in magnetic resonance cholangiopancreatography. A retrospective observational study with a prospective database was conducted. Analysis included socio demographic data, laboratory values and imaging. Bivariate, multivariate and ROC analysis was performed. Results 327 patients had intermediate risk for choledocholithiasis. Half the patients were at least 65 years old. 24.77% were diagnosed with choledocholithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocholithiasis is associated with age OR: 1.87 (p 0.02), alkaline phosphatase OR: 2.44 (p 0.02) and bile duct dilation > 6 mm OR: 14.65 (p 0.00). ConclusionsHigh variability in accuracy of imaging techniques results in a large number of patients classified as intermediate risk without choledocholithiasis in cholangio-resonance. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.
Background Choledocolithiasis is the presence of stones in the bile duct, commonly associated with cholelithiasis, with an incidence of 5-18%. Risk of choledocolithiasis should be assessed in every patient who must undergo cholecystectomy to define the next step, which can be either surgical or endoscopic. The American Gastroenterology Society (ASGE) proposed a predictor scale of choledocolithiasis based on ultrasound findings, liver function tests, and the presence of pancreatitis and/or cholangitis. Therefore we aim to describe our experience managing patients with intermediate risk of choledocolithiasis according to the ASGE guidelines and actual presence of bile duct stones in magnetic resonance cholangiopancreatography. MethodsA retrospective observational study with a prospective database was conducted. Patients over 18 years old who complied with inclusion criteria between January and December 2019, were registered. Descriptive statistics of all study parameters were provided. Analysis included socio demographic data, laboratory values and imaging. Bivariate, multivariate and ROC analysis was performed. Results 327 patients with biliary disease were classified as having intermediate risk for choledocolithiasis. Half the patients were at least 65 years old (iqr 20). All patients underwent MRI cholangiography. 24.77% were diagnosed with choledocolithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocolithiasis is associated with age OR: 1.87 (p 0.02), alkaline phosphatase OR: 2.44 (p 0.02) and bile duct dilation < 6 mm OR: 14.65 (p 0.00). ConclusionsThere is a high proportion of patients classified as intermediate risk who did not have choledocolithiasis by colangioresonance. There is a persistently high variability in accuracy of imaging techniques in intermediate risk patients. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.
BackgroundRisk of choledocholithiasis should be assessed in every patient who must undergo cholecystectomy to define the next step. American Society for Gastrointestinal endoscopy (ASGE) proposed a stratified predictor scale of choledocholithiasis. MethodsTo describe our experience managing patients with intermediate risk of choledocholithiasis according to the ASGE guidelines and actual presence of bile duct stones in magnetic resonance cholangiopancreatography. A retrospective observational study with a prospective database was conducted. Analysis included socio demographic data, laboratory values and imaging. Bivariate, multivariate and ROC analysis was performed. Results 327 patients had intermediate risk for choledocholithiasis. Half the patients were at least 65 years old. 24.8% were diagnosed with choledocholithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocholithiasis is associated with age OR: 1.87 (p 0.02), alkaline phosphatase OR: 2.44 (p 0.02) and bile duct dilation > 6 mm OR: 14.65 (p 0.00). ConclusionsHigh variability in accuracy of imaging techniques results in a large number of patients classified as intermediate risk without choledocholithiasis in cholangio-resonance. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.
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