Acta Chir Belg
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We present the case of a 17-year old male patient with a symptomatic congenital posterolateral diaphragmatic hernia with acute onset of symptoms. He was admitted to our emergency department a few days after the onset of symptoms. A large thoracic herniation on the left side was seen on chest X-ray. ⋯ Semi-urgent surgery was performed by a laparoscopic approach. The diaphragmatic defect was closed with interrupted sutures. The operation and postoperative recovery were uneventful.
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Ganglioneuromas are rare, benign, well-differentiated, slowgrowing tumors of the sympathetic nervous system, composed of large, mature neurons in a stroma composed of Schwann cells. Ganglioneuromas are derived from the neural crest cells and can arise anywhere from the base of the skull to the pelvis. The pre-sacral area is a very rare location for ganglioneuromas to develop. ⋯ The following work-up, revealed the mass to be growing on imagery (computed tomography and magnetic resonance imagery) and fluorine-18 fluorodeoxiglucose avid. The mass was removed by assisted laparoscopy and was found to be a benign ganglioneuroma. This is the first described case of fluorine-18 fluorodeoxiglucose avid, pre-sacral, benign ganglioneuroma.
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A traumatic abdominal wall hernia (TAWH) is an uncommon complication of abdominal trauma. Handlebar hernia is an even rarer type of traumatic abdominal wall hernia, with only 33 previously reported cases in literature. It is caused by a local trauma with a handlebar-like object which is not sharp enough to penetrate the elastic skin, but has sufficient focused force to breach the muscle and fascia of the abdominal wall. ⋯ Early repair is mandatory to avoid complications. The choice for primary repair versus mesh repair will be discussed according to the size of the hernia and the amount of tissue destruction by the trauma. The type of mesh used for the repair will be determined by presence or absence of contamination in the abdomen.
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Incisional hernia (IH) is a common complication of abdominal surgery. Its incidence has been reported as high as 39.9%. Many factors influence IH rates. Of these, surgical technique is the only factor directly controlled by the surgeon. There is much evidence in the literature on the optimal midline laparotomy closure technique. Despite the high level of evidence, this optimal closure technique has not met wide acceptance in the surgical community. In preparation of a clinical trial, the PRINCIPLES trial, a literature review was conducted to find the best evidence based technique for abdominal wall closure after midline laparotomy. ⋯ Careful analysis of the literature indicates that an evidenced based optimal midline laparotomy closure technique can be identified. This technique involves single layer closure with a running suture, using a slowly absorbable suture with a suture length to wound length ratio of four or more and a short stitch length. We adopt this technique as the PRINCIPLES technique.
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Comparative Study
The use of single incision thoracoscopic pleurectomy in the management of malignant pleural effusion.
A number of procedures have been used in the management of malignant pleural effusion including repeated thoracentesis, tube thoracostomy, drainage with catheter, chemical pleurodesis, pleurectomy and pleuro-peritoneal shunt. However, the optimal method of management remains unclear. On the other hand, single incision thoracoscopic surgery has been defined as a less invasive method than the standard threeportal videothoracoscopy. We herein present our series of patients who underwent single incision thoracoscopic pleurectomy for malignant pleural effusion. ⋯ Single incision thoracoscopic pleurectomy is a safe, less invasive and an effective method of pleurodesis with a low recurrence rate in patients with malignant pleural effusion.