Angioplasty and stenting emerged as the less invasive treatment options compared to open surgical revascularization for the management of patients with chronic mesenteric ischemia (CMI). However, endovascular techniques may not achieve symptomatic relief in many patients with CMI. We report our results from the endovascular management of patients with CMI. Data were reviewed from 45 patients undergoing celiac and/or mesenteric angioplasty and stenting for CMI, from October 2006 to January 2016. Angioplasty and stenting of celiac and/or mesenteric arteries were successful in relieving symptoms completely in 29 of 45 and partially in 6 of 45 patients. Only 10 of 45 patients mentioned no improvement, while symptom recurrence occurred in another 3 of 45 patients between 3 and 36 months postprocedurally due to stent occlusion. Angioplasty and stenting of celiac and/or mesenteric arteries provide symptomatic relief in a considerable percentage of patients with CMI. If symptoms fail to improve, an open surgical revascularization procedure should be considered.
Background: An extralevator abdominoperineal excision can leave a wide perineal wound. Such large wounds are prone to infection and perineal herniation, especially in patients undergoing long courses of chemo/radiotherapy. The choice of wound closure is a challenge to most surgeons. Different approaches to the perineal repair exist, varying from primary or mesh closure to myocutaneous flaps. Each technique has advantages, but also complications. Rectus abdominis muscle flaps are very successful in reducing complications of perineal wound breakdown and hernia formation, but they require an open large wound in the abdomen or laparotomy. We describe a laparoscopic surgical technique which achieves harvesting a rectus abdominis muscle flap for perineal closure while it avoids making a large abdominal laparotomy wound.
The case of a 79-year old man who was suspected to have an insulinoma is presented. Although clinically and biochemically an insulinoma was the most probable diagnosis there was no supportive radiological evidence. Open surgery and exploration revealed a lesion which was confirmed to be an insulinoma. The patient's hypoglycaemia improved immediately following surgery. In the Sri Lankan setting where sophisticated imaging procedures are not freely available, open exploration of the pancreas is a good alternative to locate a suspected insulinoma.
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