Presented herein is a case of a patient who, during a laparoscopic herniorrhaphy, developed profound bradycardia upon introduction of the pneumoperitoneum. Following discharge, the patient presented 24 h later with herniation through the trocar port incision. With laparoscopic surgery being used more frequently, there will be an increase in the incidence of these types of complications; however, with better awareness, they may be avoided.
BackgroundWound healing is a goal for advanced technology in the surgical space to benefit clinical outcomes. Surgical staplers are commonly used in a variety of open and minimally invasive abdominal and thoracic procedures. Assessment of wound healing traits, such as perfusion, has been challenging due to technical limitations. A novel technique that utilizes micro-computed tomography methodology to measure perfusion was designed to compare the micro-perfusion of staple lines between commercial stapler reloads that employ different staple height strategies.Materials and methodsFollowing an Institutional Animal Care and Use Committee-approved protocol, rats were euthanized and immediately heparinized prior to a subtotal gastrectomy with either graduated-height or single-height staples. Rats were then perfused with barium, following which stomachs were removed and immediately fixed in formalin to prevent degradation. Stomachs were then imaged using micro-computed tomography and subsequent analysis was utilized to quantify fluid volume and patent vasculature proximity to staples within the staple line region for each group.ResultsAverage perfusion volume was significantly higher with graduated-height staples (0.33% ± 0.18%) compared to single-height staples (0.16% ± 0.09%, P=0.011). Average vessel-to-staple line distance was not significant but trended lower with graduated-height staples (0.35±0.02 mm) compared to single-height staples (0.36±0.03 mm, P=0.18).DiscussionGraduated-height staples had significantly higher perfusion volume than single-height staples, which likely has a downstream benefit on wound healing and clinical outcomes.ConclusionThis study shows a higher perfusion volume around the staple lines using graduated-height staples as compared to single-height staples and this may contribute to better wound healing in patients.
Three patients with large splenic artery aneurysms (SAA) are presented, together with a review of the possible etiologies and the clinical and therapeutic aspects. SAA should be suspected in any patient with left upper quadrant pain and unexplained blood loss, especially if the patient is pregnant, and should be aggressively treated as outlined here.
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