Acta Chir Belg
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Growing popularity of laparoscopic interventions must bring along a thorough knowledge of possible complications inherent to the laparoscopic technique. With these two cases of residual appendicitis following incomplete appendectomy, the authors want to warn for this complication. Surgeons should be aware of residual appendicitis as a possible cause of acute abdomen at any time following a laparoscopic appendectomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective randomized study of Lichtenstein open tension-free versus laparoscopic totally extraperitoneal techniques for inguinal hernia repair.
Ideal technique for effective inguinal hernia repair is still controversial. Although open tension free mesh techniques of inguinal hernia repair offers good results but the superiority of laparoscopic technique was reported for postoperative pain, discomfort and earlier return back to work. A prospective, randomized study was conducted to compare Lichtenstein open tension free mesh technique with the laparoscopic totally extraperitoneal technique. 62 male patients with Lichtenstein open tension free mesh technique and 61 male patients with totally extraperitoneal technique were operated and compared postoperatively. ⋯ Operating time for totally extraperitoneal hernia repair was 16 minutes longer than Lichtenstein open tension free technique. The totally extraperitoneal technique was considerably expensive than Lichtenstein technique, however the duration of returning back to work was shorter in patients repaired with totally extraperitoneal technique. In conclusion in primary inguinal hernia repair Lichtenstein technique should be preferred and the totally extraperitoneal technique should be considered for recurrent and bilateral hernias.
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In Western Europe the most frequent cause of multiple injuries is blunt trauma. Only few of us have experience with penetrating trauma, without exception far less than in the USA or South-Africa. In Rotterdam, the Erasmus Medical Centre is a level I trauma centre, situated directly in the town centre. ⋯ In a work-up according to ATLS principles airway, breathing and circulation should be evaluated with great care. Neurovascular examination related to trauma of the spinal cord, peripheral nerves as well as vascular involvement should be carried out also in extremity injuries. Physical examination should be completed by localization of all stabwounds, in- and outshot openings as well as recto-vaginal examination and inspection of the oropharynx.
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In this review we elaborate on the more specific circumstances that are needed for adequate trauma care, such as the correct recognition and management of a tension pneumothorax, a tracheobronchial disruption, systemic air embolism and hypoventilation. Furthermore the trauma clinician must be aware of the different life threatening causes of haemorrhage and hypovolemia. Traumatic pericardial tamponade, myocardial contusion and a tension pneumothorax can all prove to be difficult diagnoses, but may all present with signs of hypotension with an increase in central venous pressure (CVP). ⋯ Furthermore, we stress the importance of the swift diagnosis and treatment of fractures of long bones and the pelvis, to prevent ongoing massive haemorrhage. Certain criteria should be met, in a hospital setting with sufficient day-to-day trauma experience, to be able to provide quality care for the multi-trauma patient. This will minimise the risk of errors and serious medical and judicial consequences.
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Case Reports
How can we approach a left-sided stab wound in the neck, with isolated tracheal laceration?
Any penetrating trauma to the mediastinum may cause great vessel damage resulting in massive bleeding or even shock. Associated tracheal injury increases morbidity and mortality. We report a case of a penetrating mediastinal injury with isolated tracheal laceration. ⋯ Bronchoscopy revealed two injuries in the trachea that were repaired by right thoracotomy and left cervicotomy. The patient was discharged on postoperative day 6. Isolated thoracic tracheal injury is very rare in mediastinal stab wounds and operative strategy may change according to bronchoscopic findings.