Many surgeons are familiar with Amyand hernia, which is an inguinal hernia sac containing an appendix. However, few surgeons know of the contribution of Rene Jacques Croissant de Garengeot, an 18th century Parisian surgeon, to hernias. He is quoted in the literature as the first to describe the appendix in a femoral hernia sac. We discuss the case of an 81-year-old woman who presented with appendicitis within a femoral hernia, a rare finding at surgery that is almost never diagnosed preoperatively. We also propose crediting Croissant de Garengeot by naming this condition after him. Although his full last name is Croissant de Garengeot, for convenience we suggest the simple diagnosis of “de Garengeot hernia.”
Same-day discharge after peripheral angioplasty is safe and cost-effective. Need for admission is evident within 2 hours. Routine admission after peripheral angioplasty for patients with claudication is unnecessary and should no longer be the standard of care.
The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to evaluate the incidence of postoperative surgical site infections (SSIs) between laparoscopic (LAP) and open colorectal surgery. The 2008 ACS-NSQIP Participant Use File was queried by Current Procedural Terminology codes for colorectal surgery cases. SSI rates were compared between groups using Pearson chi-square and Fisher exact tests. Univariate and multivariate analyses were performed to identify factors associated with the LAP approach and/or SSIs. A total of 7,755 LAP and 16,184 open cases were identified. The laparoscopic group had an SSI rate of 9.4 versus 15.7 per cent for the open group ( P < 0.0001). There was no statistical difference in the type of SSI (superficial, deep, and/or organ space) between the two groups. Although multivariate analysis identified several factors associated with SSIs of different types, LAP was the only factor found to decrease risk, whereas wound class and operative time were found to increase risk among all categories of SSIs. Despite a significantly lower incidence of postoperative SSI, only 32 per cent of colorectal surgery was performed laparoscopically in NSQIP hospitals in 2008. Wider adoption of LAP approaches for colorectal surgery should continue to reduce SSIs.
Background: The small intestinal bacterial overgrowth (SIBO) breath test has had positive results in 84% of patients with irritable bowel syndrome vs 20% of controls. We hypothesized that SIBO would be more prevalent in patients with symptoms consistent with irritable bowel syndrome who have undergone previous abdominal surgery.
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