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Buero A, Olivera Lopez SB, Tchercansky A, Pankl LG, Chimondeguy DJ, Samudio M, Mendez J, Lyons GA. [Malignant melanotic nerve sheath tumor of the posterior mediastinum]. Medicina (B Aires) 2024; 84:324-328. [PMID: 38683517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Melanotic schwannoma (MS) is a rare and infrequent subtype of schwannoma characterized by cytoplasmic deposits of melanosomes (melanin). Unlike the other schwannomas, it could have malignant transformation. Due to distinctive characteristics and atypical behavior from classic schwannomas subtypes, MS were renamed and reclassified as "melanocytic malignant neural sheath tumor" in the 5th ed. of the World Health Organization's classification of central nervous system tumors in 2021. We present two cases of MS that underwent complete surgical resection.
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Affiliation(s)
- Agustín Buero
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Buenos Aires, Argentina. E-mail:
| | | | - Ariel Tchercansky
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Leonardo G Pankl
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Domingo J Chimondeguy
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Mayra Samudio
- Servicio de Diagnóstico por Imágenes, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Julián Mendez
- Servicio de Anatomía Patológica, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo A Lyons
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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2
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Perri M, Pellegrini D, Uribe Roca C, Gonzalez F, Buero A, Chimondeguy D, Bruetman JE. [Stiff person syndrome associated with thymoma]. Medicina (B Aires) 2023; 83:626-630. [PMID: 37582138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Stiff-person syndrome is a rare neurological condition characterized by muscular rigidity of the trunk and extremities and muscle spasms triggered by sensory or emotional stimuli, which progresses towards prostration. It has a pathophysiogenic mechanism with an immunological basis, in which autoantibodies, such as antiGAD65, play a central role. Likewise, the detection of these antibodies corroborates the diagnosis in a patient with a suggestive clinical picture. Four to 6% of cases have underlying neoplasms. Treatment is based on symptomatic, immunomodulatory, and underlying disease management in paraneoplastic cases. We report a case of classic stiff person syndrome associated with thymoma and review the main characteristics of this entity.
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Affiliation(s)
- Marcella Perri
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina
| | - Debora Pellegrini
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina. E-mail:
| | | | - Fabio Gonzalez
- Servicio de Neurología, Hospital Británico de Buenos Aires, Argentina
| | - Agustín Buero
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | | | - Julio E Bruetman
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina
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3
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Toffolo Pasquini M, Auvieux R, Tchercansky A, Buero A, Chimondeguy D, Mendez J. [Catamenial pneumothorax]. Medicina (B Aires) 2022; 82:147-150. [PMID: 35037874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Thoracic endometriosis syndrome (TES) is a rare disorder characterized by the presence of ectopic endometrial tissue in the chest cavity. The typical clinical manifestation is a spontaneous pneumothorax, which usually presents with chest pain, dyspnea, and/or cough. The diagnosis requires a high level of clinical suspicion and a complete gynecological history. Imaging studies can help with the diagnosis, although the gold standard is video-assisted thoracoscopic surgery (VATS). Surgical treatment in combination with at least 6 months of hormonal medical treatment has been shown to improve the prognosis and reduce the recurrence of this entity. We present the case of a 40-year-old patient with a history of pelvic endometriosis and multiple episodes of pneumothorax, who consulted at our institution for a new episode of spontaneous pneumothorax. A VATS was performed where nodules in the parietal pleura and diaphragmatic orifices were identified. In the postoperative period, she continued with hormonal treatment. At 6 months of follow-up, she reported improvement in pain and did not present new episodes of pneumothorax.
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Affiliation(s)
| | - Rodolfo Auvieux
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | - Ariel Tchercansky
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | - Agustín Buero
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | | | - Julián Mendez
- Servicio de Anatomía Patológica, Hospital Británico de Buenos Aires, Argentina
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4
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Buero A, Chimondeguy DJ, Auvieux R, Tchercansky AN, Pankl LG, Lyons GA, Gonzalez FM, Leon Cejas L, Reisin R, Méndez J. [Outcomes of surgical treatment for thymic epithelial neoplasms]. Medicina (B Aires) 2022; 82:376-382. [PMID: 35639058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Thymic epithelial tumors are a group of rare neoplasms of the mediastinum. When resectable, complete resection is considered the gold standard for any stage. The primary endpoint was to evaluate overall survival and disease-free survival of patients with thymus epithelial tumors who underwent surgical treatment. The secondary endpoint was to evaluate and compare the overall survival according to: resection type (complete vs. incomplete), Masaoka-Koga stage and tumor histology according to WHO classification. This is a descriptive observational study from January 2004 to December 2020, in which 42 patients with a postoperative histopathological diagnosis of thymic epithelial tumours were included. Thirty-nine were thymomas (92.9%) and 3 were thymic carcinomas (7.1%). In all patients a total thymectomy was performed. The median follow-up was 63.5 months (IQR 32-97.5). The estimated overall survival at five and ten years was 87% (95% CI, 0.69-0.95) and 78% (95% CI, 0.5-0.92), respectively. Estimated diseasefree survival at five and ten years was 90% (95% CI, 0.74-0.96). Patients who underwent complete resection and with early Masaoka-Koga stages had superior overall survival compared to incomplete resections and advanced Masaoka-Koga stages (p = 0.0097 and p = 0.0028, respectively). We found no differences in terms of survival between histological subtypes due to a low number of patients in the thymic carcinoma group.
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Affiliation(s)
- Agustín Buero
- Servicio de Cirugía Torácica, Hospital Británico, Buenos Aires, Argentina. E-mail:
| | | | - Rodolfo Auvieux
- Servicio de Cirugía Torácica, Hospital Británico, Buenos Aires, Argentina
| | | | - Leonardo G Pankl
- Servicio de Cirugía Torácica, Hospital Británico, Buenos Aires, Argentina
| | - Gustavo A Lyons
- Servicio de Cirugía Torácica, Hospital Británico, Buenos Aires, Argentina
| | - Fabio M Gonzalez
- Servicio de Neurología, Hospital Británico, Buenos Aires, Argentina
| | | | - Ricardo Reisin
- Servicio de Neurología, Hospital Británico, Buenos Aires, Argentina
| | - Julián Méndez
- Servicio de Patología, Hospital Británico, Buenos Aires, Argentina
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5
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Tchercansky AN, Buero A, Auvieux R, Korbenfeld E, Mendez J, Chimondeguy D. Incidental pulmonary carcinoid tumorlet associated with lung cancer. Medicina (B Aires) 2022; 82:297-299. [PMID: 35417395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Lung tumorlets are rare neuroendocrine neoplasms of 0.5 cm or less in diameter that extend beyond the basement membrane. Although they are associated with bronchiectasis and fibrosis they tend to be asymptomatic and behave in a benign way, usually being diagnosed as incidental microscopic nests of neuroendocrine cells in lung tissue. We present a case of a pulmonary tumorlet finding after right upper lobectomy for lung cancer.
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Affiliation(s)
- Ariel N Tchercansky
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina. E-mail:
| | - Agustín Buero
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | - Rodolfo Auvieux
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | - Ernesto Korbenfeld
- Servicio de Oncología Clínica, Hospital Británico de Buenos Aires, Argentina
| | - Julián Mendez
- Servicio de Anatomía Patológica, Hospital Británico de Buenos Aires, Argentina
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Young P, Chimondeguy D, Montes Onganía A, Pankl L, Monkowski M, Buero A, Auvieux R, Finn BC, Bruetman JE, Ernst G, Lyons G. [Bilateral video-assisted thoracic sympathicotomy for hiperhidrosis: analysis of 102 patients]. Medicina (B Aires) 2021; 81:54-61. [PMID: 33611245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Hyperhidrosis is a disorder consisting of excessive sweating through the different body sweat glands, which produces a negative impact socially and in work-related activities in those that suffer this condition. There are primary and secondary forms. The primary form is a benign condition with excessive sweating mainly in palms, soles of feet, axillae and face. It affects a 1% of the population, and its cause is unknown. Most medical treatments are unsuccessful, and at best, transitory. In patients who are very troubled by the condition, videoassisted bilateral thoracic sympathicotomy has become the elective treatment. In the period ranging from 1998 to 2018, 174 procedures were undertaken for primary hyperhidrosis, of which 102 satisfied the inclusion criteria. 72 patients were excluded. A 20.5% were males, and 79.5% were females, with an average age of 29.22 years at surgery. As to localization of sweating, a 50.9% was palmar-plantar-axillary, 23.5% axillary, 10.7% palmarplantar, 7.8% palmar, 6.8% palmar-axillary, and a 5.8% facial. Those patients with palmar sweating showed a 94.9% improvement, those with axillary sweating a 88.51%, with plantar a 46.25% and those with facial sweating a 84% improvement. The average admission time was 1.1 days. As an undesired effect, compensatory sweating occurred in 53 cases and postoperative complications in 18 cases. We conclude this is a safe technique, that diminishes sweating significantly, improving patient's quality of life.
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Affiliation(s)
- Pablo Young
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina. E-mail:
- Departamento de Docencia e Investigación, Hospital Británico de Buenos Aires, Argentina
| | | | | | - Leonardo Pankl
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | - Matías Monkowski
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina
| | - Agustín Buero
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | - Rodolfo Auvieux
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
| | - Bárbara C Finn
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina
| | - Julio E Bruetman
- Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Argentina
| | - Glenda Ernst
- Departamento de Docencia e Investigación, Hospital Británico de Buenos Aires, Argentina
| | - Gustavo Lyons
- Servicio de Cirugía Torácica, Hospital Británico de Buenos Aires, Argentina
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7
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Buero A, Chimondeguy DJ, Auvieux R, Pankl LG, Lyons GA, Tchercansky AN, Gutierrez V. [Resection of the first rib by video thoracoscopy in Paget-Schroetter syndrome]. Medicina (B Aires) 2021; 81:31-36. [PMID: 33611242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. The aim of this article was to describe our experience in a minimally invasive approach (VATS) of first rib resection for primary venous thoracic outlet and the associated outcomes. This is a descriptive observational study using a retrospective analysis of a prospective database from January 2017 to March 2020. Nine patients underwent video thoracoscopic first rib resection due to Paget- Schroetter syndrome (one bilateral procedure). Ten thoracoscopic first rib resections were performed. There were 6 female and 3 male patients, with a mean age of 30.7 ± 10.7 years. The mean length of hospital stay was 3.1 ± 0.5 days. No complications were recorded intraoperatively. One patient had to be re-operated because of hemothorax. There were no recurrences in a follow-up of at least 12 months. VATS resection of the first rib is a safe and feasible procedure and can be performed under direct vision of thoracic outlet elements. However, the technique requires experience with thoracoscopic surgery. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.
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Affiliation(s)
- Agustín Buero
- Servicio de Cirugía Torácica, Hospital Británico, Buenos Aires, Argentina. E-mail:
| | | | - Rodolfo Auvieux
- Servicio de Cirugía Torácica, Hospital Británico, Buenos Aires, Argentina
| | - Leonardo G Pankl
- Servicio de Cirugía Torácica, Hospital Británico, Buenos Aires, Argentina
| | - Gustavo A Lyons
- Servicio de Cirugía Torácica, Hospital Británico, Buenos Aires, Argentina
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Buero A, Quadrelli S, Pankl LG, Vigovich F. Two-year disease remission of an unresectable basaloid thymic carcinoma with second line chemotherapy drugs: report of a case. Pan Afr Med J 2019; 33:53. [PMID: 31448016 PMCID: PMC6689853 DOI: 10.11604/pamj.2019.33.53.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 12/27/2018] [Indexed: 11/13/2022] Open
Abstract
Thymic carcinomas are extremely infrequent neoplasms (15% of all thymic epithelial tumors). Basaloid carcinoma is a peculiar tumor that represents no more than 2% of those infrequent thymic carcinomas. Surgical excision is the recommended treatment. As it's extremely rare, there is no evidence of the impact of different modalities of treatment. There are no reported cases that did not include surgery as part of their management. We herein present a case of an unresectable thymic basaloid carcinoma treated only with concurrent chemotherapy and radiotherapy that obtained a complete remission and free of disease after 2 years.
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Affiliation(s)
- Agustín Buero
- Department of Thoracic Surgery, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Silvia Quadrelli
- Department of Pneumonology, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Leonardo German Pankl
- Department of Thoracic Surgery, Buenos Aires British Hospital, Buenos Aires, Argentina
| | - Felix Vigovich
- Department of Pathology, Buenos Aires British Hospital, Buenos Aires, Argentina
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Buero A, Nardi WS, Lyons GA, Quadrelli S, Chimondeguy DJ. Entirely thoracoscopic resection of a giant emphysematous bulla. Pan Afr Med J 2019; 30:247. [PMID: 30627308 PMCID: PMC6307922 DOI: 10.11604/pamj.2018.30.247.12400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/22/2018] [Indexed: 11/23/2022] Open
Abstract
A 38-year-old man with longilinear shape, smoker (38 packs/year) and no other relevant medical history was referred to our department due to the finding of left pulmonary hyperlucency on a chest x-ray. A computed tomography (CT) was performed and a giant emphysematous bulla with thin-walled partitions inside was shown that replaced almost the entire left upper lobe, The patient underwent an exploratory thoracoscopy. Intraoperatively a giant bulla was seen that initially impressed to replace the entire upper lobe. Despite the large size we decided to attempt thoracoscopic resection preserving the remaining healthy parenchyma. Bullectomy was done using linear endoscopic stapling devices. To our knowledge this is the only case with such a large bulla resected entirely by VATS.
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Affiliation(s)
- Agustín Buero
- British Hospital of Buenos Aires, Buenos Aires, Argentina
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10
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Abstract
A 46-year-old man was referred to our department due to chronic chest pain. A computed tomography showed an exophytic image arising from 5th rib that was projected on the middle lobule. The patient underwent an exploratory videothoracoscopic because we couldn't discard lung compromise. A corneal-like lesion emerging from the inner side of the 5th rib was revealed. Complete video-assited resection was done. Histopathology examination revealed a desmoplastic fibroblastoma. To our knowledge this is the first case of desmoplastic fibroblastoma arising from a rib and the second case published in all literature of chest wall involvement.
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Affiliation(s)
- Agustín Buero
- Department of Thoracic Surgery, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Walter Sebastian Nardi
- Department of General Surgery, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Dezanzo
- Department of Pathology, British Hospital of Buenos Aires, Buenos Aires, Argentina
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11
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Abstract
A 55-year-old man with no medical history of relevance was referred to our department for chronic back pain. Plain radiographs of the abdomen showed a round calcified image with liquid level inside in the upper-left quadrant. On computed tomography (CT) a bulky solid-cystic mass with calcified wall of 65 × 34 mm was shown in the left adrenal gland with no-contrast enhancement. The patient underwent a laparoscopic approach. Intraoperatively there was a large hard stony mass depending on the left adrenal gland, which was entirely supplanted by the tumor. Complete excision was done. The patient underwent uneventful recovery. Histopathology examination showed a solid-cystic mass with a thick fibrous wall and calcified areas compatible with hydatid cyst. To date there have been published few cases of adrenal hydatid cyst. To our awareness it is the fourth case issued in all literature resected by the laparoscopic approach.
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Affiliation(s)
- Walter Nardi
- Department of General Surgery, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Agustín Buero
- Department of General Surgery, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Santiago Lozano
- Department of General Surgery, British Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Eduardo A Porto
- Department of General Surgery, British Hospital of Buenos Aires, Buenos Aires, Argentina
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Buero A, Silberman EA, Medina P, Morra ME, Bogetti DJ, Porto EA. Laparoscopic repair of a small bowel herniation through a broad ligament defect. J Minim Access Surg 2014; 10:166-7. [PMID: 25013338 PMCID: PMC4083554 DOI: 10.4103/0972-9941.134887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/26/2013] [Indexed: 11/04/2022] Open
Abstract
A 44-year-old female presented with a diagnosis of intestinal obstruction from unknown origin. Laparoscopy revealed herniation of small bowel trough a defect in the left broad ligament. After reduction, the defect was corrected laparoscopically. The post operative recovery was uneventful.
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Affiliation(s)
- Agustín Buero
- Department of General Surgery, Hospital Británico de Buenos Aires, Argentina
| | | | - Pablo Medina
- Department of General Surgery, Hospital Británico de Buenos Aires, Argentina
| | - Matias E Morra
- Department of General Surgery, Hospital Británico de Buenos Aires, Argentina
| | - Diego J Bogetti
- Department of General Surgery, Hospital Británico de Buenos Aires, Argentina
| | - Eduardo A Porto
- Department of General Surgery, Hospital Británico de Buenos Aires, Argentina
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