Acta Chir Belg
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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.
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Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot's triangle. ⋯ Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.
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Detection of small bowel injury after blunt abdominal trauma can be challenging. Occurrence is rare, but delay in the diagnosis and surgical repair increases patient morbidity and mortality. ⋯ On arrival at the emergency department, physical examination and imaging modalities were reassuring. The maintenance of high clinical suspicion led us to perform an exploratory laparotomy that brought the ileal perforation to light.
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Frostbite as a result of mountaineering or arctic expeditions is a well-known problem. In this article a rare case of frostbite injury following a paragliding accident at high altitude is described. ⋯ The frostbite was initially treated by rewarming, with later debridement and local application of silver sulfadiazine and povidone-iodine dressings. Within three months all the injuries were healed.