P126 LAPAROSCOPIC TREATMENT OF HYDROCELE IN FEMORAL CANAL: A CASE REPORT

Aim The hydrocele of the femoral canal (Femorocele) is one of the rarest entities of femoral hernia (1). All of the reported cases were an intraoperative diagnosis and were treated with an open approach. We are reporting, the probably first femorocele diagnosed and treated laparoscopically. Material and Methods A 57-years-old female patient was presented in our outpatient clinic with pain and an unclear lump in the groin area for 6 months. The sonographic examination revealed a cystic structure in the groin area resampling Nuck’s cyst. An elective laparoscopic exploration and transabdominal preperitoneal (TAPP) repair was planned. Results A laparoscopic exploration was carried out. Intraoperatively, the cystic structure was not found in the Nuck’s Canal, but in the femoral canal as a content of a femoral hernia with some pre-peritoneal fat. By the extraction of the cyst, a gush of clear fluid was noted. After the usual preparation of the preperitoneal area, a mesh was placed in TAPP technique. Conclusions This rare variety of femoral hernias, femorocele, is commonly misdiagnosed as a strangulated hernia or Nuck’s cyst (as in this case) among other differential diagnoses (2). All published femorocele cases were treated with an open approach. As demonstrated here, such unclear cases can be laparoscopically explored and treated accordingly.

Extramammary Borderline Phyllodes Tumor Presenting as an Umbilical Mass

Phyllodes tumors (PTs) represent a spectrum of rare, fibroepithelial neoplasms of the breast, which can be subcategorized as benign, borderline, or malignant based on their histological appearance. Accessory breast tissue may present anywhere along the embryological mammary ridge, and at distant locations as aberrant breast tissue. We present the case of a 56-year-old lady with an umbilical mass, thought to represent a strangulated hernia. Sections showed a fibroepithelial tumor with leaf-like ducts, conspicuous mitotic activity (up to 8 per 10 high-power fields), and focal infiltration into fat. Immunohistochemical studies showed diffuse positivity of epithelial cells for estrogen receptor, mammaglobin, GCDFP-15, and CK7. These findings were consistent with a borderline PT. This is the first case report of PT presenting as an umbilical mass, and the first extramammary borderline PT described.

Outcome of laparoscopic transabdominal preperitoneal repair for complicated inguinal hernia in adults at the Hue Central Hospital - II

Introduction: Laparoscopic approaches for inguinal hernia, including transabdominal preperitoneal repair (TAPP) and the totally extraperitoneal approach (TEP), are effective and widely accepted in elective inguinal hernioplasty. The choice an procedure for complicated inguinal hernia repair still controversial. Since the TAPP approach has advantages in assessing hernia content and decreasing incision infection rate and early recovery after surgery. Materials and Methods: Study participants included 17 patients of complicated inguinal hernia treated by TAPP technique at the Hue Central Hospital - Base 2 from 6/2019 though 6/2020. Descriptive and prospective follow-up study. Results: The mean age was 67,4 ± 14,85. Strangulated hernia and incarcerated hernia respectively accounted for 41,2% and 58.8% among cases. 94,1% cases were indirect hernia. 12 cases (70,6%) were right sided and 5 cases (29,4%) were left sided hernias. The content was small bowel in 58,8% cases, omentum in 23,5% cases and both in 11,8% cases, colon in 5,9%. 7 patients of strangulated hernia with recovery bowel and non resection. The mean durations of unilateral inguinal hernia repair were 77,2 ± 19.3 mins. Mean duration of postoperative stay was 4.2 ± 2.1 days. Postoperativer complications were 5,9% seroma formation. At 6-months evaluation, 1 case was reported with sensation disorder of inguinal area and there was no recurrence. Conclusions: TAPP is a safe and effective surgical technique for incarcerated inguinal hernia repair. Keywords: Strangulated inguinal hernia, incarcerated, TAPP, laparoscopic, mesh. Tóm tắt Đặt vấn đề: Phẫu thuật nội soi điều trị thoát vị bẹn ngày càng phổ biến rộng rãi với hai phương pháp TEP (totally extraperitoneal) và TAPP (transabdominal preperitoneal). Những trường hợp thoát vị bẹn có biến chứng việc lựa chọn phương pháp điều trị vẫn còn nhiều quan điểm khác nhau. Với cách tiếp cận bên trong khoang phúc mạc phương pháp TAPP có lợi thế trong việc đánh giá tạng thoát vị, giảm tỉ lệ nhiễm trùng và hồi phục nhanh sau phẫu thuật. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả, theo dõi dọc 17 người bệnh thoát vị bẹn có biến chứng được phẫu thuật TAPP tại Bệnh viện Trung ương Huế - Cơ sở 2 từ 06/2019 đến 06/2020. Kết quả: Tuổi trung bình 67,4 ± 14,85 tuổi. Thoát vị bẹn nghẹt 7 người bệnh (41,2%); thoát vị bẹn cầm tù 58,8%. 94,1% thoát vị thể gián tiếp. Bên phải có 12 người bệnh chiếm 70,6%, bên trái 29,4%. Tạng thoát vị được giải phóng 58,8% ruột non; 29,4% mạc nối; 11,8% ruột non và mạc nối và 5,9% là đại tràng. 7 người bệnh thoát vị nghẹt có sự hồi phục ruột non không phải cắt bỏ. Thời gian phẫu thuật trung bình 77,2 ± 19,3 phút. Thời gian nằm viện sau mổ trung bình 4,2 ± 2,1 ngày. Biến chứng sớm sau phẫu thuật 5,9% tụ dịch bẹn bìu. Sau 6 tháng có 1 trường hợp rối loạn cảm giác vùng bẹn; không có trường hợp nào tái phát

Е. Maylard. Strangulated hernia of the left ovary in the femoral region. (Brit. Med. Journ. 1892, Apr. 9). Restrained femoral hernia of the left ovary.

Patient girl, 25 years old. For the first time, she covered up a small tumor in her left groin in the summer of 1888. The appearance of this tumor was accompanied by frequent urge to urinate and the inability to empty the bladder. The horizontal position and pressure on the tumor made not only the tumor disappear, but also the concomitant phenomena from the bladder. The size of the tumor was equal to the bean.

Early outcome of laparoscopic Transabdominal Pre-Peritoneal technique in adult patients with inguinal hernia repair at the Hue Central Hospital - Base 2

Tóm tắt Đặt vấn đề: Thoát vị bẹn là bệnh lý phổ biến trong ngoại khoa, đặc biệt lĩnh vực ngoại tiêu hóa. Từ khi phẫu thuật nội soi ra đời và ứng dụng tấm nhân tạo trong điều trị thoát vị bẹn, đã có những thay đổi trên thế giới về điều trị cho người bệnh thoát vị bẹn. Phương pháp phẫu thuật nội soi đặt tấm nhân tạo đường xuyên phúc mạc TAPP (Trans-Abdominal Pre-Peritoneal) có nhiều ưu điểm như đường cong huấn luyện ngắn, phát hiện thoát vị bẹn đối bên và điều trị cả trường hợp có biến chứng, nên được nhiều phẫu thuật viên trẻ lựa chọn. Phương pháp nghiên cứu: Nghiên cứu tiến cứu, lâm sàng mô tả, theo dõi dọc 19 người bệnh với 21 trường hợp thoát vị bẹn được phẫu thuật TAPP tại Bệnh viện Trung ương Huế - Cơ sở 2 từ tháng 12/2018 đến 3/2019. Kết quả: Tuổi trung bình 66,8 ± 14,35. Thoát vị bẹn nghẹt 4,8%. Thoát vị bẹn cầm tù 9,5%. Thời gian phẫu thuật trung bình một bên 65,3 ± 19,6 phút, hai bên 102,5 ± 12,5 phút. Thời gian hậu phẫu trung bình 4,1 ± 1,6 ngày. Phát hiện 2 trường hợp thoát vị bẹn đối bên. Sau 3 tháng không có trường hợp nào tái phát. Kết luận: Phẫu thuật TAPP là một phẫu thuật an toàn, hiệu quả có thể ứng dụng rộng rãi. Abstract Introduction: Inguinal hernia repair is one of the most common operation performed in general surgery, especially in digestive field. Since the introduction of laparoscopic repair and application of synthetic mesh to treatment, the trends have changed in the last decade in treatment for inguinal hernia. The laparascopic trans-abdominal pre-peritoneal (TAPP) has a short learning cure. TAPP has many advantages, such as wide dissection, contralateral side checkup, treatment strangulated hernia and incarcerated hernia, a short learning cure has been the first choice for surgeons. Materials and Methods: Study subjects included 19 patients with 21 inguinal hernia cases treated by laparoscopic trans-abdominal pre-peritoneal (TAPP) technique at the Hue Central Hospital - Base 2 from 12/2018 though 3/2019. Descriptive and prospective follow-up study. Results: The mean age was 66,8 ± 14,35 years old. Strangulated hernia and incarcerated hernia respectively accounted for 4,8% and 9.5% of cases. The mean durations of unilateral inguinal hernia repair and bilateral inguinal repair were 65,3 ± 19,6 mins and 102,5 ± 12,5 mins, respectively. Mean duration of postoperative stay was 4,1 ± 1,6 days. 2 case (3.2%) with contralateral inguinal hernia were detected. At 3-months evaluation, there was no recurrence. Conclusion: TAPP is a safe and effective surgical technique; should be encouraged and widely applied in different levels hospitals. Keyword: inguinal hernia, TAPP, laparoscopic surgery, mesh.

TECHNOLOGIES OF PROSTHETIC PLASTY OF STRANGULATED HERNIA

Summary. Surgical treatment of hernia with the use of prosthetic plasty methods is a pressing problem of modern surgery and herniology. The use of mesh implants for strangulated hernias needs further development and improvement. Material and methods. 375 strangulated hernias of various localization were subjected to analysis (12.8 % of all hernias (2926) for the period 2005-2018), of which inguinal — 138 (36.8 %), femoral — 31 (8.3 %), umbilical — 112 (29.9 %), white line of the abdomen — 31 (8.3 %), postoperative — 63 (16.8 %). Autohernioplasty was performed in 134 (35.7 %), prosthetic plasty — in 241 (64.3 %) (on lay — 5, sub lay — 121, in lay — 7, Liechtenstein’s operation - 102). Results. For the periods 2005-2010. and 2011-2018. the relative amount of autohernioplasty decreased 2.6 times (from 57.3 % to 22.4 %) (p <0.0001, χ2 = 32.605), and prosthetic plasty increased 1.8 times (from 42.7 % to 77.6 %) (p <0.0001, χ2 = 59.784). The resection of the intestine was performed when the hernia was strangulated in 31 cases, and in with autohernioplasty - in 17 cases (54.8 %) and allohernioplasty - in 14 (45.2 %). Opportunities for the use of a mesh implant, even with bowel resection, were found in 45.2 % of patients. Postoperative mortality was 0.53 % (2 patients). Conclusion. 1. The use of mesh implants for strangulated hernias is characterized by an increase in the frequency of their use by a factor of 1.8. 2. When resecting the intestine for strangulated hernia, prosthetic plasty can be performed in 45.2 % of patients. 3. The developed technologies of implant fixation at reference points, the use of two-layer prosthetic plasty can reduce the number of relapses and improve the results of surgical treatment of strangulated abdominal wall hernia.

The role of computed tomography in the diagnosis of rare pelvic hernias on the example of strangulated hernia of the obturator canal: review

Obturator hernia is a rare form of pelvic hernia that is more common in older women. The clinical diagnosis of hernia is difficult. This type of hernia cannot be visualized by a general examination, and it is also impossible to reveal it by palpation, that is why it is more often detected at the stage of complications and is accompanied by high mortality. This work presents observation of a strangulated hernia of the obturator canal in a 96-year-old patient diagnosed with computed tomography.