1/6. Synchronically performed laparoscopic cholecystectomy and hernioplasty.Cholecystectomies and hernioplasties are the two most frequently performed surgical interventions. The laparoscopic technique can be offered for the simultaneous treatment with both operating indications. The synchronical operation can give all the advantages of the minimally invasive technique. Authors had performed laparoscopic cholecystectomy with laparoscopic hernioplasty in five cases. Two inguinal and three postoperative hernias were reconstructed. The cholecystectomy was performed with a "three punction method", and the hernioplasty by using the same approach, completed by inserting a fourth assisting trocar as required. The hernial ring was covered with an intraperitoneally placed mesh, which was fixed by staplers (the so-called "IPOM-method": intraperitoneal on-lay mesh). There was no intra-, nor postoperative complication. The hernioplasty combined with laparoscopic cholecystectomy did not have effect on postoperative pain and nursing time. The return to the normal physical activity was short, similar to laparoscopic hernioplasty (in 1-2 weeks). Authors conclude that the simultaneous, synchronous laparoscopic cholecystectomy and hernioplasty is recommended and should be the method of choice because it is more advantageous for patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Laparoscopic resection of an abdominal wall desmoid using a modified suture traction technique: the "marionette trick".Desmoids are rare mesenchimal tumors that may originate also inside the abdomen or in the abdominal wall. These tumors are biologically characterized by a tendency to local growth, and only rarely are they able to develop distant metastases. Surgical excision usually is the best treatment with a chance of a cure. In the few reports on intraabdominal or abdominal wall desmoids, open surgery always was performed. The first case of successful laparoscopic resection of a symptomatic anterior wall desmoid tumor with intraabdominal growth is reported. During the procedure, it was difficult to mobilize and grasp the mass using the common laparoscopic instruments, but with the help of the "marionette trick," modified suture traction technique, the tumor could be removed easily using only three trocars. With four traction sutures minimizing the wall trauma, the trick made it possible to mobilize the mass in at least, seven directions, according to the principles of physical forces and vectors. This simple trick can be helpful for other common laparoscopic procedures, avoiding the insertion of sometimes ineffective instruments through more traumatic trocars.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. empyema of the gallbladder: a case with unusual presentation.A case of gallbladder empyema associated with multiple complications caused by a delay in diagnosis is presented. Recent literature is reviewed especially emphasizing the clinical presentation with scanty physical signs. Greater awareness of the indolent and chronic presentation might reduce the considerable morbidity and mortality that are associated with delayed operative intervention.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Clostridial sepsis: unusual clinical presentations.We present four cases exhibiting the widely diverse nature of clinical infections due to anaerobic clostridium perfringens. These cases exemplify the need for a thorough initial physical examination, immediate Gram staining of fluid from involved tissue, and recognition of the severity of the disease in any patient who has early septic deterioration after elective or emergency surgical procedures. Management of these infections includes both high-dose parenteral penicillin therapy and aggressive initial surgical debridement of all involved tissues.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Acute acalculous cholecystitis following multiple skeletal trauma. A report of three cases.Three cases of acute acalculous cholecystitis are reported in patients with multisystem failure following major long-bone trauma. The diagnosis should be suspected in any such patient who develops septicaemia from an unidentified site. A high index of suspicion should be maintained, especially in patients who are sedated or in receipt of mechanical ventilation of the lungs and in whom physical signs may be minimal or absent.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Spontaneous external biliary fistula in a patient with heroin addiction.Spontaneous external biliary fistula, once common, is now a rare clinical entity. A patient with this lesion is described and attention is drawn to the fact that this rare condition is still being seen in certain patients with neglected cholecystitis. heroin addiction was thought to have modified his response to gallbladder disease and contributed to the perforation. diagnosis was suspected on physical examination and confirmed by spontaneous discharge of stones and fistulogram.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |