Breast reduction with short L scar

I didactically compared the breast as a glandular cone with an envelope of skin and subcutaneous tissue. The aesthetic alterations of the breast are classified in four groups related to form, to volume, to grams, and to ptosis in centimeters. An imaginary plane that passes by the mammary sulcus (plane A) will determine the area of the breast that is ptotic. The projection of this plane in the anterior part of the breast is called point A. The distance between point A and the nipple will give in centimeters the amount of ptosis. I use this distance to draw geometrically in the breast the amount of excess of skin to be removed to correct the ptosis. In group I, the volume is normal and part of the mammary gland is under plane A. In this type of breast, the skin is resected, and since there is no excess of breast tissue, the breast that is under plane A is used as an inferior pedicle flap to give a better volume to the new breast. In group II, the base of the breast is large, the height is normal, and the volume is increased by the enlargement of the base. In this type of breast, the excess of breast under plane A and a wedge under the nipple are resected to reach the normal volume at the end of the surgery. In group III, the base is normal and the volume of the breast is increased by the height. For treatment, I resect the excess of breast under plane A as well as a segment at the base to reduce its height. In group IV, the volume of the breast is increased by the size of the base and the height of the cone, and I treat by resection of the excess of tissue under the ptotic area, a wedge under the areola, and a transversal segment in the base to reduce all the dimensions. In the final result of this technique in the majority of patients I will obtain a short scar. This technique was used in 1083 patients from January of 1979 to May of 1988.

Breast capsulopexy for capsular ptosis after augmentation mammaplasty

A simple and reliable technique of capsulopexy is presented. A total of six inferiorly displaced inframammary folds were thus corrected during the past 8 years with good results and with an average of 3.2 years of follow-up. It is felt that this method is simple, reliable, and easier than other techniques previously reported in the literature.

[Treatment and prevention of urinary stress incontinence by the Bologna procedure in prolapse with large cystocele. Surgical technic]

Bologna's procedure allows the curative or preventive treatment for urinary stress incontinence during surgical cure of prolapse with large cystocele (2nd or 3rd degree). An infra-cervical sling is created with 2 vaginal bands dissected from the anterior colpocele, passed through the retropubic space on either side of the bladder neck and fixed to the abdominal wall, after making a suprapubic approach to the aponeurosis of the rectus abdominis muscle. This colposuspension technique, performed via a mixed approach, is generally accompanied by vaginal hysterectomy and colpectomy designed to treat the various elements of the prolapse. This operation is easily reproducible and the postoperative course is generally uneventful. The intermediate term anatomical and functional results are very satisfactory in women over the age of 60 years. There is not sufficient follow-up at the present time to consider this procedure for young women.

Small omphalocele with ileal prolapse through a patent omphalomesenteric duct. A case report and review of literature

A patent omphalomesenteric duct is an uncommon condition. These lesions are prone to give a small bowel prolapse, which complicates the situation. We report 1 such patient. Early surgical management is necessary to prevent complications.

Mesh fixation of the mesentery for treatment of volvulus and recurrent stomal prolapse

Mesenteric mesh-pexy is indicated for permanent and quick-clean fixation of the intestine. It is applicable to the treatment of recurrent stomal prolapse and intestinal volvulus when the intestine is viable, but resection, less definitive treatment or an additional operation would pose increased risks to the patient. Mesenteric mesh-pexy may also be considered prophylactically for floppy cecum and severely redundant loops of sigmoid colon.

A simple technique for correction of severe gastrostomy leakage

A simple method for the correction of severely leaking or prolapsing gastrostomies, or both, is presented. The stoma is relocated using a new catheter in a manner similar to our previously described percutaneous endoscopic gastrostomy. The old stoma is closed extraperitoneally. The procedure is simple, fast and safe and has proved to be effective in seven high risk patients.

Correction of mammary ptosis with glandular atrophy

Excess skin and insufficient gland are two problems posed by the correction of the small ptotic breast. A single-stage operation can resolve these problems. Our technique used for 20 patients proved satisfactory with a low rate of complications.

A technique for temporary control of colostomy prolapse in children

Stomal prolapse is a common complication of colostomies and, if severe, may affect the timing of the definitive procedure. A simple technique for postreduction bowel fixation without stomal revision is presented. The reduced bowel is attached to the parietal peritoneum using a "U" type suture a few centimeters from the stoma. Two short parallel segments of latex tubing prevent the thread from cutting through. Suture and bolsters are removed when adhesions are established. In one of the four children, a percutaneous cecostomy was employed to connect a prolapse of the entire proximal colon.

[A rare complication of vaginal hysterectomy: vaginal evisceration. Apropos of a case of recurrent evisceration]

A patient developed repeated vaginal eviscerations after vaginal hysterectomy. This is a rare complication, only 21 cases having been reported in the literature. The present case was a 61 year old woman with post-vaginal hysterectomy eviscerations 8 and 21 months after the operation. Reduction of the herniated loop and suturing of the ununited vaginal stump is generally a simple procedure, but the perineal reconstruction necessary to prevent recurrence raises problems that are discussed in detail.

Rubber band ligation versus haemorrhoidectomy for prolapsing haemorrhoids: a long term prospective clinical trial

Eighty patients with prolapsing haemorrhoids, randomly treated by either rubber band ligation (n = 39) or haemorrhoidectomy (n = 41), were assessed 12 and 42 months after treatment. Thirty-eight patients in each group presented with rectal bleeding. Twelve months later, 36 in the rubber band ligation group and 37 in the haemorrhoidectomy group had benefited from treatment. After 42 months, all patients in the rubber band ligation group reported improvement in this symptom; one in the haemorrhoidectomy group did not. At 12 months all but one patient in the rubber band ligation group and all in the haemorrhoidectomy group had improved with respect to haemorrhoidal prolapse. At 42 months all except one in each group reported improvement in this symptom. Anal pain, pruritus ani and soiling are symptoms commonly associated with haemorrhoids. All were improved by both rubber band ligation and haemorrhoidectomy. Neither technique was superior in this respect and there was no change in results between 12 and 42 months.

Relief from symptoms of haemorrhoids at 12 months, obtained by rubber band ligation or by haemorrhoidectomy, is maintained 42 months after treatment. Thus, rubber band ligation has a good long term outcome and, as a convenient outpatient procedure, should continue to be advocated as the first-line management for prolapsing haemorrhoids.

[Genital prolapse in elderly women (150 cases) (author's transl)]

A series of 150 operations, by the same surgeon, for genital prolapse in women over 60 years of age (range to 85 years), represented 36% of the total number of operations for prolapse performed. A total of 32 women had had previous prolapse operations, 24 developed prolapse after hysterectomy, and 11 had postoperative colpoceles. This means that 45% had iatrogenic lesions, term in fashion at the present time but which strongly emphasizes the role played by insufficiently defined operative indications, and operations conducted without sufficient rigour. The most frequent lesions, were firstly cystoceles, then external prolapses, followed by hysteroceles. Urinary incontinence was evident in 15%, and potential in at least 10% of continent women. The lower approach was employed for the operation, either obturating or conservative, in most cases. When the upper approach was used, this was mainly for pathogenic purposes, and adapted to the lesion. Overall results were excellent, and only two irreversible accidents occurred. Recurrences were mainly in the form of cystoceles, micturition disorders, or sometimes rectocele sequelae. Increased life-span and improved operative treatment should make the surgery of prolapse in elderly women even more effective.

[Ileocecal mucosal prolapse]

Knowledge of normal and pathological anatomy and the radiological picture of the ileocecal valve is very important to avoid false interpretation of polyp-like findings in the cecum. Radiologically, ileal prolapse can pose as a cecal polyp. The radiological diagnosis, large 'cecal polyp' was not confirmed intraoperatively in the case presented.

Prolapse of the laryngeal ventricle

Many varied lesions may protrude into the laryngeal lumen from between the true and false vocal cords. These protrusions can be precisely diagnosed only by biopsy. Prolapse of the laryngeal ventricle is one of these lesions; it is a distinct clinicopathologic entity, a primary lesion unrelated to other laryngeal or systemic disease. Eversion of the ventricle (or saccule) is a similar protrusion that is secondary to pulsion or traction by an associated laryngeal lesion. Other lesions that may produce similar clinical findings and gross appearance include benign tumors, cysts, and, rarely, squamous cell carcinoma. Biopsy is therefore mandatory to plan rational treatment. A review of 26 patients who had been diagnosed as having prolapse resulted in the reclassification of 20 cases of prolapse and six cases of eversion. Prolapse is possibly unrelated etiologically to cough, or chronic laryngeal or respiratory tract infection. The histopathologic data suggest further that prolapse is a result of fatty infiltration, edema, and inflammation of the periventricular tissue above the ventricle, which cause the tissue to enlarge and protrude into the laryngeal lumen from between the true and false vocal cords.

Surgical correction of the fatty fallen neck

A report is presented on surgical correction of the fatty fallen neck, with mention of possible complications. Surgical treatment of the relaxed platysma in these cases is also described, and a surgical technique suggested for correcting prolapse of the submandibular gland and its supporting structures.

Medial thigh lift

Medial thigh ptosis, characterized by rhytidosis and seen commonly from aging and great weight loss, is seldom improved by lateral or posterior thigh lift. A simple procedure has been developed to correct this laxity of the upper, inner thighs. This consists of symmetrical resection of a crescent-shaped segment of skin and subcutaneous tissue having the distribution of an L1 embryological dermatome, just inferior to the inguinal crease. Despite temporary sensory loss and spreading of scars in some patients, the procedure has been gratifying to both patient and surgeon. Patients must be carefully selected, as the procedure does not correct either trochanteric lipodystrophy or ptosis, or lipodystrophy medial to and just superior to the knee.

[Congenital partial defect of the pericardium with herniation of the left atrial appendage (author's transl)]

Congenital partial pericardial defect with herniation of the left atrial appendage presents a rare anomaly. Clinical appearance of a 25-year-old man with this anomaly combined with adherance to the left lung hilus and the pericardial sac is described. He suffered from cardiac arrhythmias and dyspnea during exertion. The chest X-ray film at unremarkable physical examination and routine laboratory data within normal limits showed a prominent shadow of the left cardiac border, the cineangiocardiographic findings revealed that the prominence was due to a large left atrial appendage. Since strangulation of the left atrial appendage is a well-known and described potential hazard, thoracic surgery was performed without any complication.

A new look at pelvic relaxation

The concept is presented that most cystoceles and/or urethroceles result from insolated defects in the connective tissue supports of the anterior quadrant of the pelvis. Four areas in which defects have been found to occur are identified. Sixty patients are presented who were found to have isolated defects in the endopelvic fascia at the lateral sidewall of the pelvis with significant cystourethroceles and stress urinary incontinence. The surgical treatment consisted only of a direct approach to and closure of the isolated defect. The operative results at 3 to 48 months were excellent in 91.7 per cent, improved in 5 per cent, and failed in 3.3 per cent. Discussion is offered of the possibility of the study of the pelvic floor from the viewpoint of a mechanical engineer.