A three layered repair of a large perineal hernia: case report and review of the literature

BACKGROUND

A symptomatic perineal hernia is an uncommon complication after abdominoperineal resection (APR). Repairs of such hernias can be achieved by usage of autologous flaps, synthetic mesh, or biologic mesh, which reduce bowel adhesions. Studies have shown that prophylactic repair of the pelvic floor with biologic mesh during APR, can reduce the incidence of perineal hernia.

CASE PRESENTATION

A 71-year-old woman, after extended APR (eAPR) with primary closure of pelvic floor with absorbable mesh, presented to our outpatient clinic with a symptomatic, extensive perineal hernia. The patient underwent repair of the perineal hernia using a synthetic mesh and a bilateral gluteal flap procedure. In post operative care, signs of surgical site infection and a fluid collection demonstrated in a CT-scan, compelled a surgical drainage. A clear fluid negative for bacterial growth was drained and antibiotic treatment was initiated. After drainage, surgical site showed signs of significant improvement and patient was eventually discharged.

CONCLUSION

The rise in reported incidence of perineal hernia after eAPR coupled with the scarcity of data regarding the preferable repair technique suggests that there is a significant need for further prospective comparative studies.

Establishing a Laparoscopic Surgical Skills Laboratory Using a porcine Model: Is There a Place for Live Tissue Simulators in an Operating Room Setting?

BACKGROUND

Achieving laparoscopic competency is challenging. Common laparoscopic simulators usually fall short in achieving true simulation.

OBJECTIVES

To present a live porcine model laparoscopic skills laboratory for training general surgery residents.

METHODS

An in vivo porcine laparoscopic model course was developed to simulate seven different laparoscopic procedures and seven laparoscopic skills for trainees under the tutelage of laparoscopic specialists.

RESULTS

A total of 98 surgical trainees from 19 training programs underwent a full-day course from September 2017 to July 2020. Each program consisted of four trainees and two faculty members. In total, 175 laparoscopic procedures were performed. Trainees reported that the course improved their ability to perform in the operating room.

CONCLUSIONS

Using a laparoscopic porcine model in a guided didactic course performing complete common laparoscopic procedures in simulated operating room surroundings was beneficial for surgical trainees. The porcine model mimics human abdominal anatomy and allows trainees to increase their comfort level in performing such procedures.

One-third of children with lactose intolerance managed to achieve a regular diet at the three-year follow-up point

AIM

This study described outcomes following treatment for lactose intolerance, which is common in children.

METHODS

The medical records of children aged 6-18 years who underwent lactose hydrogen breath testing at Dana-Dwek Children's Hospital, Tel Aviv, Israel, from August 2012 to August 2014 were analysed. We compared 154 children with gastrointestinal symptoms and positive lactose hydrogen breath tests to 49 children with negative test results.

RESULTS

Of the 154 children in the study group, 89 (57.8%) were advised to follow a lactose-restricted diet, 32 (20.8%) were advised to avoid lactose completely, 18 (11.7%) were instructed to use substitute enzymes, and 15 (9.7%) did not receive specific recommendations. Only 11 patients (7.1%) received recommendations to add calcium-rich foods or calcium supplements to their diet. Lactose reintroduction was attempted in 119 of 154 patients (77.3%), and 65 of 154 (42.2%) experienced clinical relapses. At the final follow-up of 3.3 years, 62.3% of the study children were still observing a restricted diet. Older children and those who were symptomatic during lactose hydrogen breath testing were more likely to be on a prolonged restricted diet.

CONCLUSION

Our long-term follow-up of lactose-intolerant children showed that only a third were able to achieve a regular diet.