The elective treatment of a spigelian hernia is still under discussion, fundamentally owing to its rarity. The purpose of the study is to analyze the elective surgical treatment of spigelian hernia.Design: A prospective, randomized controlled trial.Setting: University teaching hospital.Patients and Interventions: Two surgeons performed 11 conventional and 11 laparoscopic repairs for a spigelian hernia, alternating roles as primary surgeon and assistant. Each time the type of technique was randomly chosen using a computerized program.Main Outcome Measures: Epidemiological, clinical, and surgical factors are analyzed according to treatment, ie, the open or laparoscopic approach.Results: The statistical study shows no significant differences for epidemiological or diagnostic factors, but it does show significant advantages for laparoscopy in terms of morbidity (PϽ.05) and hospital stay (PϽ.001). Conclusion:The approach using extraperitoneal laparoscopy is the technique that offers best results in the elective treatment of spigelian hernia.

Surgery can be avoided in most patients with rectus sheath haematoma. Although the numbers were small, CT appeared to be more accurate than ultrasonography in facilitating the diagnosis.

This study examined the association between parental involvement and mental well being among the 6721 school going adolescents aged 13 to 15 years who participated in Indias nationally representative Global School based Student Health Survey (GSHS) in 2007. Parental involvement (homework checking, parental understanding of their childrens problems, and parental knowledge of their childrens freetime activities) was reported by students to decrease with age, while poor mental health (loneliness, insomnia due to anxiety, and sadness and hopelessness) increased with age. Age adjusted Logistic regression models showed that high levels of reported parental involvement were significantly associated with a decreased likelihood of poor mental health.

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Spigelian hernias are rare defects of the abdominal wall. Our aim is to analyse the bibliography and present a series of 28 patients. A Medline bibliographical study was performed between 1970 and 2000 with analysis of the number of cases, series, ratio of cases to year and type of journal. We also present a personal study and analyse epidemiological, diagnostic, and treatment factors. There are 159 articles, 479 cases, and 19 series of more than five patients published in 85 journals (42.3% medical). Our diagnosis was preoperative in 75%, and programmed surgery was 3.6 times more common than emergency surgery. We found a significant relationship between hospital stay and type of surgery (P < 0.02) and surgical technique used (P < 0.001). We found that spigelian hernias have a multidisciplinary interest; they are given almost equal treatment in medical and surgical journals; preoperative diagnosis can be established in 75% of cases; and the best results are offered by the extraperitoneal laparoscopic approach.

A manometric study to determine the role of gastro-oesophageal reflux in Barrett's oesophagus was performed on 20 patients with Barrett's oesophagus and 53 patients with reflux oesophagitis without Barrett's oesophagus (25 with mild oesophagitis and 28 with severe oesophagitis). For the same reason, the 20 patients with Barrett's oesophagus also underwent 24 hour continuous oesophageal pH monitoring, and the results obtained were compared with those of 20 oesophagitis patients without Barrett's oesophagus (10 with mild oesophagitis and 10 with severe oesophagitis). The manometric results show that the motor changes found in the Barrett's group are specific but similar to the motor dysfunction associated with reflux oesophagitis. Motor anomalies are probably related more to the inflammatory process in the oesophageal wail than to the metaplastic changes themselves. The pH monitoring results show that while reflux in the Barrett's oesophagus patients was greater overall than in the oesophagitis group without Barrett's oesophagus, the changes are similar when the results are compared with the severe oesophagitis group. In conclusion there are other factors besides gastro-oesophageal reflux involved in the pathogenesis of Barrett's oesophagus.

Laparoscopic repair of ventral and incisional hernias is still a controversial therapeutic option. The purpose of this article is to evaluate the results of laparoscopic surgery on ventral hernias in an outpatient surgery unit of a university hospital. Fifty-five patients consecutively underwent laparoscopic surgery for ventral/incisional hernias in the outpatient unit. The patients' clinical features, hernia type, intraoperative, and postoperative complications and reasons for hospital admission are studied. Forty-two patients (76%) were discharged on the day of the surgery. Thirteen (24%) required hospital admission; 9 admissions were predictable (5 for intraoperative occurrences and 4 for associated surgery) and 4 were unpredictable (all for uncontrolled pain; 31%). We found no case of hospital admission for vomiting, urinary retention, or dizziness. Statistical analysis of the patients requiring admission showed no significant correlation with their clinical features or with the site, size, or recurrence of the abdominal wall defect (P > 0.05). Laparoscopic repair of ventral and incisional hernias can be done as a highly efficient ambulatory procedure, and morbidity and hospital admission with this technique do not depend on the type of hernia.