This report describes an alternative technique for Petit hernia repair. The treatment of lumbar hernias should follow the concept of tension-free surgery, and the preperitoneal space can be the best place for prosthesis placement. An obese patient had a bulge in the right lumbar region, which gradually grew and became symptomatic, limiting her daily activities and jeopardizing her quality of life. She had previously undergone 2 surgical procedures with different incisions. We created a preperitoneal space and attached a mesh in this position. Another prosthesis was placed on the muscles, with a suitable edge beyond the limits of the defect. There were no complications. It has been described as a safe and tension-free repair for Petit hernia. In larger defects, a second mesh can be used to prevent further enlargement of the triangle and also to provide additional protection beyond the bone limits.
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) presents high incidence throughout the world and has been progressively increasing in prevalence. This disease has a heterogeneous natural history, including simple steatosis, nonalcoholic steatohepatitis (NASH), and cirrhosis. The factors that determine its evolution to more severe forms of the disease are still poorly understood, and micronutrients with antioxidant potential may be involved in the pathophysiology of the disease. AIM To evaluate the relationship between serum levels of micronutrients and the severity of NAFLD. METHODS A retrospective, observational and cross-sectional study was conducted. This study included all patients undergoing bariatric surgery who experienced liver biopsy during the procedure, and had serum levels of micronutrients (vitamin D, vitamin B12, zinc, iron, and magnesium), which was assessed in a preoperative evaluation conducted at a reference center in southern Brazil. RESULTS A total of 614 patients were analyzed, of which 93% had steatosis, 70.7% had NASH, and 49.3% had some degree of fibrosis. Serum levels of vitamin D were negatively correlated with the severity of steatosis and NASH, and serum levels of vitamin B12 were positively correlated with the severity of steatosis and fibrosis. The other micronutrients showed no association with NAFLD staging. CONCLUSION Serum levels of vitamin D are inversely related to the severity of steatosis and NASH, and serum levels of vitamin B12 are higher in more advanced stages of simple steatosis and liver fibrosis. Serum levels of zinc, iron, and magnesium were not associated with NAFLD severity.
OBJETIVO: Relatar a experiência do nosso Serviço com a descompressão cirúrgica da árvore biliar através de uma hepatojejunostomia periférica. MÉTODO: Entre julho de 2000 a julho de 2005, 11 pacientes foram à laparotomia para ressecção de tumores do hilo hepático e, durante o trans-operatório, apresentavam lesões irressecáveis. Os dados analisados foram: idade, sexo, morbidade, mortalidade, dosagem de bilirrubinas séricas pré-operatórias e no 7ºdia de pós-operatório, prurido pré e pós-operatório e sobrevida. RESULTADOS: A idade média dos pacientes foi de 67 anos, seis eram mulheres e cinco eram homens. Icterícia estava presente em 100% dos casos e prurido em 80%. Seis pacientes tiveram o diagnóstico de neoplasia de vesícula biliar e cinco de colangiocarcinoma. Ocorreram três óbitos intra-hospitalares. A dosagem média no pré-operatório de bilirrubina total foi 19,33mg/dl e bilirrubina direta 16,81mg/dl e no pós-operatório 4,88mg/dl e 3,64mg/dl, respectivamente. Oito pacientes que receberam alta hospitalar tiveram sobrevida média de oito meses, evoluindo sem icterícia e prurido. CONCLUSÃO: A hepatojejunostomia periférica pode ser considerada uma boa opção como tratamento paliativo . Ela demonstrou ser segura, com sangramento mínimo, rápida execução e mortalidade aceitável, melhorando significativamente a icterícia, o prurido e fornecendo uma sobrevida satisfatória.
Anastomotic fistula represents one of the frequent causes of postoperative morbidity and mortality following transhiatal esophageal resections. The main etiological factor is the ischemia of the gastric tube created for digestive transit reconstruction. Evidence suggests that per operative hypoperfusion can be maintained or even impaired after the surgery. Several methods have been employed in an attempt to assess the blood perfusion of the gastric flap, but they all pose limitations. However, there is a chronological relationship between perfusion assessments, which are almost exclusively performed per operatively, and the occurrence of a leak, which commonly appears several days after the surgery. The authors have developed a method of gastric perfusion evaluation by single photon emission computed tomography scintigraphy, which corrects that temporal matter, allowing the estimation of postoperative gastric perfusion. It is noninvasive, low cost, and may be applied by the time frame when most fistulas occur. High correlation between the event fistula and the low radiotracer uptake in the group of studied patients could be demonstrated. A role in the research of perfusion evaluation of different types of esophageal reconstruction is suggested.
Introduction: The management of acute abdomen in super-obese patients is controversial.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.