HighlightsMelanoma skeletal muscle metastasis (MSMM) are exceptional.Despite all new advances in melanoma therapy, cure for most MSMM is still elusive.This is the third case of an isolated metastasis of melanoma to the rectus abdominis muscle published in the literature.Radical compartmental surgery should be considered for selected stage IV melanoma patients, with isolated rectus abdominis MSMM, whose disease could be amenable to complete resection, in order to extend median survival.Nowadays, the use of synthetic meshes seems to be one of the best choices for repairing the abdominal wall defect.
HighlightsProsthetic meshes used for repair abdominal defects may lead to false-positives FDG PET/CT uptake.Awareness of false positive FDG PET/CT secondary to periprosthetic seroma is essential.A positive diagnosis is needed to avoid misinterpretations and inappropriate treatments.
PRPL is a rare extrauterine entity probably derived from remnant embryogenic cells. The absence of clinical guidelines recommend an individualized treatment of these patients. Karakousis's abdominoinguinal approach should be present in any surgeon's armamentarium as the resectability-rate of tumors of the lower quadrant of the abdomen increases up to 95%.
Background and Objectives:
Less than 300 cases of a De Garengeot’s hernia have been published. This rare femoral hernia with the vermiform appendix included appears almost exclusively on the right side, mainly in females, and it generally debuts as an incarcerated femoral hernia. Although most of the times there is a concomitant appendicitis, clinical signs of peritonitis are absent. The wide use of radiologic exams has not favored its preoperative diagnosis, but been usually found incidentally during a surgical emergency. The best surgical approach to a De Garengeot’s hernia is not totally defined and many critical questions still remain unanswered. Open surgery is considered the standard treatment procedure, but since the emergence of laparoscopy for incarcerated hernias, this is certainly an option.
Methods:
We report the successful laparoscopic management of an 83-year-old woman who had been operated on her right inguinal hernia, with a Rutkow-Robbins’ technique, 4 months earlier. She had noticed the protrusion of a lump in her right inguinal region for 2 months. Radiological studies were not conclusive. With a miss diagnosis of a recurrent incarcerated inguinal hernia, a minimal invasive endoscopic approach was performed. A representative case of this fully laparoscopic TAPP procedure is presented.
Results:
The patient made an uninterrupted recovery. She left the hospital the day after in a stable condition and has enjoyed good health since.
Conclusion:
A fully laparoscopic TAPP approach seems perfectly safe and feasible to treat this entity, and could be considered the first line alternative when enough expertise is available.
Purpose
Less than 450 cases of femoral hernias containing the vermiform appendix have been published since De Garengeot’s first description. A laparoscopic treatment option opened 15 years ago seems reliable and safe. A literature review of all the patients who have benefited from this new therapeutic alternative is presented.
Methods
A systematic review using the German Society of Surgery’s recommendations was performed for De Garengeot’s hernias totally treated laparoscopically. Keywords searched included “De Garengeot hernia” OR “femoral hernia appendix” OR “crural hernia appendix.”
Results
Only 29 out of 225 De Garengeot hernia’s manuscripts were identified describing patients entirely treated laparoscopically: 25 patients by a transabdominal preperitoneal hernia repair (TAPP) and 4 patients by a total extraperitoneal (TEP) procedure; 85.1% were females. The mean age was 71 years. Twenty-two patients had pre-operative imaging tests, sonography (2), computed tomography (14), or both (6). Nevertheless, only 56% had a preoperative diagnosis. Twenty-one cases required urgent treatment, while programmed surgery was possible in 7 instances. An appendix-sparing procedure could be done in 16% of the TAPPs. No postoperative complications occurred. The median hospital stay was 2.5 days.
Conclusions
The best surgical approach for a De Garengeot’s hernia is not defined, and many critical questions remain unanswered. A better understanding of the diagnosis and treatment of this peculiar hernia will supply guidelines for clinicians who may encounter it hereafter. A fully laparoscopic approach seems perfectly safe and feasible for this entity, and it could be considered the first-line alternative if enough expertise is available.
calculated. The correlation between both scores was evaluated and both scores have been used to compare predicted and observed intra-operative outcomes in LLR. Results: During a period of 7 years, 320 LLR were performed by a single surgeon. Median blood loss was 10ml (IQR:50-150ml) and median operative time was 130min (IQR: 90-180min). Conversion rate was 2.5% and blood transfusion rate was 2.8%. Major complication rate (Clavien-Dindo Grade III) was 3.1% with 0.94% 90-days mortality. R0 resection rate was 93.6%.Correlation between both difficulty scores was poor (r=0.53). Both blood loss and operative time were poorly correlated to both IDS (r=0.36 and r=0.56 respectively) and SDS (r=0.22 and r=0.51 respectively). Both difficulty scores were significantly different in patients undergoing LLR (mean difference 1.5, st. dev. = 2.3, p<0.0001) Conclusion: Both validated difficulty scores perform poorly in predicting intra-operative Results for LLR. Further multi-center analyses need to be performed to investigate predicting factors. Caption 1: Graph plotting both difficulty scores, showing low correlation between both scores.
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