scholarly journals PRIMARY ABANDON-OF-THE-SAC (PAS) TECHNIQUE: PRELIMINARY RESULTS OF A NOVEL MINIMALLY INVASIVE APPROACH FOR INGUINOSCROTAL HERNIA REPAIR

Author(s):  
Alexander Charles MORRELL ◽  
Andre Luiz Gioia MORRELL ◽  
Flavio MALCHER ◽  
Allan Gioia MORRELL ◽  
Alexander Charles MORRELL-JUNIOR

ABSTRACT Background: Laparoscopic best approach of repairing inguinoscrotal hernias are still debatable. Incorrect handling of the distal sac can possibly result in damage to cord structures and negative postoperative outcomes as ischemic orquitis or inguinal neuralgia. Aim: To describe a new technique for a minimally invasive approach to inguinoscrotal hernias and to analyze the preliminary results of patients undergoing the procedure. Methods: A review of a prospectively maintained database was conducted in patients who underwent minimally invasive repair using the “primary abandon-of-the-sac” (PAS) technique for inguinoscrotal hernias. Patient´s demographics, as well as intraoperative variables and postoperative outcomes were also analyzed. Results: Twenty-six male were submitted to this modified procedure. Mean age of the case series was 53.8 years (range 34-77) and body mass index was 26.8 kg/m2 (range 20.8-34.2). There were no intraoperative complications or conversion. Average length of stay was one day. No surgical site infections, pseudo hydrocele or neuralgia were reported after the procedure and two patients presented seroma. No inguinal hernia recurrence was verified during the mean 21.4 months of follow up. Conclusion: The described technique is safe, feasible and reproducible, with good postoperative results.

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Chiara Dobrinja ◽  
Marta Silvestri ◽  
Nicolò de Manzini

Introduction. Elderly patients with primary hyperparathyroidism (pHPT) are often not referred to surgery because of their associated comorbidities that may increase surgical risk. The aim of the study was to review indications and results of minimally invasive approach parathyroidectomy in elderly patients to evaluate its impact on outcome.Materials and Methods. All patients of 70 years of age or older undergoing minimally approach parathyroidectomy at our Department from May 2005 to May 2011 were reviewed. Data collected included patients demographic information, biochemical pathology, time elapsed from pHPT diagnosis to surgical intervention, operative findings, complications, and results of postoperative biochemical studies.Results and Discussion. 37 patients were analysed. The average length of stay was 2.8 days. 11 patients were discharged within 24 hours after their operation. Morbidity included 6 transient symptomatic postoperative hypocalcemias while one patient developed a transient laryngeal nerve palsy. Time elapsed from pHPT diagnosis to first surgical visit evidences that the elderly patients were referred after their disease had progressed.Conclusions. Our data show that minimally invasive approach to parathyroid surgery seems to be safe and curative also in elderly patients with few associated risks because of combination of modern preoperative imaging, advances in surgical technique, and advances in anesthesia care.


2019 ◽  
Vol 40 (9) ◽  
pp. 1060-1067
Author(s):  
Snow B. Daws ◽  
Kaitlin Neary ◽  
Gregory Lundeen

Background: The treatment of displaced, intra-articular calcaneus fractures is controversial. The extensile lateral approach has been historically preferred because it provides excellent exposure and visualization for fracture reduction. However, soft tissue complications with this approach can lead to poor outcomes for patients. Recently, there has been an interest in the minimally invasive treatment of calcaneus fractures. The purpose of the present study was to determine the radiographic reduction of displaced, intra-articular calcaneus fractures and the rate of complications using a 2-incision, minimally invasive approach. Methods: A dual-incision, minimally invasive approach with plate and screw fixation was utilized for the treatment of 32 patients with displaced, intra-articular calcaneus fractures. Preoperative and postoperative calcaneal measurements were taken to assess fracture reduction. Additionally, a retrospective chart review was performed to assess for complications. Results: The mean preoperative Bohler’s angle measurement was 12.9 (range, –5 to 36) degrees and the final postoperative Bohler’s angle was 31.7 (range, 16-40) degrees. One patient (3.1%) had postoperative numbness related to the medial incision in the calcaneal branch sensory nerve distribution. Two patients (6.2%) had a wound infection treated with local wound care and oral antibiotics, while 1 patient (3.1%) had a deep infection that required a secondary surgery for irrigation and debridement. Two patients (6.2%) returned to the operating room for removal of symptomatic hardware. Conclusion: Operative fixation of displaced, intra-articular calcaneus fractures treated with a 2-incision, minimally invasive approach resulted in acceptable fracture reduction with a minimal rate of complications. Level of Evidence: Level IV, retrospective case series.


2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Mark J. Russo ◽  
John Gnezda ◽  
Aurelie Merlo ◽  
Elizabeth M. Johnson ◽  
Mohammad Hashmi ◽  
...  

Background. Ministernotomy incisions have been increasingly used in a variety of settings. We describe a novel approach to ministernotomy using arrowhead incision and rigid sternal fixation with a standard sternal plating system.Methods. A small, midline, vertical incision is made from the midportion of the manubrium to a point just above the 4th intercostal mark. The sternum is opened in the shape of an inverted T using two oblique horizontal incisions from the midline to the sternal edges. At the time of chest closure, the three bony segments are aligned and approximated, and titanium plates (Sternalock, Jacksonville, Florida) are used to fix the body of the sternum back together.Results. This case series includes 11 patients who underwent arrowhead ministernotomy with rigid sternal plate fixation for aortic surgery. The procedures performed were axillary cannulation (n=2), aortic root replacement (n=3), valve sparing root replacement (n=3), and replacement of the ascending aorta (n=11) and/or hemiarch (n=2). Thirty-day mortality was 0%; there were no conversions, strokes, or sternal wound infections.Conclusions. Arrowhead ministernotomy with rigid sternal plate fixation is an adequate minimally invasive approach for surgery of the ascending aorta and aortic root.


2008 ◽  
Vol 25 (2) ◽  
pp. E10 ◽  
Author(s):  
Stephen M. Pirris ◽  
Sanjay Dhall ◽  
Praveen V. Mummaneni ◽  
Adam S. Kanter

Surgical access to extraforaminal lumbar disc herniations is complicated due to the unique anatomical constraints of the region. Minimizing complications during microdiscectomies at the level of L5–S1 in particular remains a challenge. The authors report on a small series of patients and provide a video presentation of a minimally invasive approach to L5–S1 extraforaminal lumbar disc herniations utilizing a tubular retractor with microscopic visualization.


2020 ◽  
Vol 11 (1) ◽  
pp. 97
Author(s):  
Geetika Kumar ◽  
ManviChandra Agarwal ◽  
RG Shiva Manjunath ◽  
SS Sai Karthikeyan ◽  
ShivaShankar Gummaluri

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