Hernia Research Articles

Bilateral strangulated femoral hernia in a male: a rare surgical case report

Abstract Femoral hernias are at a high risk of strangulation due to their narrow necks. They are an exceptionally rare occurrence in males. In many cases, differentiation between a femoral and inguinal hernia is difficult. We present the case of a bilateral strangulated femoral hernia in a 70-year-old male. To our knowledge, there has been only one previously published report of such a case in males. Our patient presented with generalized abdominal pain and bilateral irreducible groin swellings, originally thought to be bilateral strangulated inguinal hernia. Upon initial inguinal incision, a diagnosis of a strangulated femoral hernia was made. A modified lower midline laparotomy incision was made to gain access to and diagnose both femoral hernias and allow for bowel resection and abdominal washout. Our case highlights the importance of modifying the surgical approach when encountering with a different diagnosis intraoperatively.

Case report: strangulated spigelian hernia as an uncommon cause of intestinal obstruction

Spigelian hernias (SH) are very rare, representing approximately 0.5% to 2% of ventral wall hernia defects. Due to their low incidence, they pose a diagnostic and surgical challenge in General Surgery. This case report describes a rare strangulated Spigelian hernia causing intestinal obstruction in a 72-year-old female with a history of laparoscopic cholecystectomy. The patient presented with periumbilical pain, nausea, vomiting, and no bowel movements for 48 hours. Initial imaging suggested partial obstruction, but a CT scan confirmed herniation of ileal loops through the Spigelian aponeurosis. Surgical intervention included ileum resection, hernioplasty with mesh, and VAC drain placement. The complexity of diagnosing Spigelian hernias arises from their location, resembling umbilical or incisional hernias, and risk factors like obesity. This case emphasizes the need for accurate imaging and prompt surgery to prevent complications.

Small intestinal incarceration caused by external herniation can be diagnosed clinically in cattle, but laparotomy is required to confirm internal incarceration.

To describe the clinical, laboratory and ultrasonographic findings, treatment, and outcome of cattle with small intestinal incarceration (SII) through internal and external hernias. The medical records of 85 cattle with SII admitted between January 1, 1987, and December 31, 2019, were retrospectively reviewed. The long-term outcome was determined 2 years after discharge. 85 cattle had herniation of the small intestine through congenital or acquired openings in mesentery or omentum (internal herniation; n = 60) or the abdominal wall (external herniation; 25). The most common findings were little or no feces in the rectum (77 of 85 [90.6%]), reduced or absent intestinal motility (76 of 85 [89.4%]), and hypocalcemia (36 of 44 [81.8%]). Thirteen (15.3%) cattle died or were euthanized without surgery. Of the remaining 72 (84.7%) cattle that underwent surgery, 42 survived the procedure. Overall, 52 of 85 cattle (61.2%; 95% CI, 50% to 72%) did not survive to hospital discharge and 33 (38.8%; 95% CI, 28% to 50%) were discharged alive. Of these, 11 (33.3%; 6 with and 5 without hernias closed completely) were still productive in their respective herds 2 years later. The diagnosis of an incarcerated external hernia is usually straightforward, whereas internal SII necessitates laparotomy or postmortem examination for a definitive diagnosis. Internal herniation should be part of the differential diagnosis in cattle with signs of ileus. Immediate surgical treatment is paramount in cattle with SII.

SCROTAL HERNIATION AND STRANGULATION OF THE SMALL INTESTINE IN AN INTACT MALE 3-YEAR-OLD MIXED-BREED DOG

Importance: This case report describes a rare presentation of scrotal herniation and strangulation of the small intestine in a 3-year-old intact male mixed-breed dog. This condition is noteworthy due to its potential for severe complications and the scarcity of documented cases in the veterinary literature, contributing to the limited body of knowledge on scrotal hernias in dogs, especially those involving intestinal strangulation. Case Presentation: The dog presented with unilateral scrotal swelling, persistent vomiting and inappetence for 10 days. Physical examination revealed inflamed and tender scrotal regions, with the left side more prominently affected. Radiographic findings indicated dilated small intestines and increased radiopacity in the scrotal area. Surgical intervention revealed a swollen left testicle and a hemorrhagic loop of small intestines within the scrotum. A midline celiotomy was performed to resect and anastomose the devitalized intestinal segment, followed by herniorrhaphy. Conclusions and Relevance: The patient recovered uneventfully and resumed normal activities within a week post-surgery. This case highlights the clinical importance of timely diagnosis and surgical management of scrotal hernias in dogs to prevent life-threatening complications, underscoring the need for awareness of such presentations among veterinarians. The successful outcome in this case supports the efficacy of surgical intervention in similar scenarios, potentially guiding future clinical practices.

Clinical challenges and management of late presenting congenital diaphragmatic hernia mimicking tension pneumothorax in a child: a case report and review of literatures

BackgroundCongenital diaphragmatic hernia(CDH) is a rare congenital anomaly characterized by herniation of abdominal contents into thoracic cavity through a defect in diaphragm. While commonly diagnosed prenatally or in neonatal period, late-presenting CDH can occur and may mimic other thoracic emergencies such as tension pneumothorax, complicating diagnosis and management.Case presentationA two-year old male black child from Ethiopia presented to the emergency department with sudden onset of acute respiratory distress. Initial clinical assessment and chest radiography suggested a diagnosis of tension pneumothorax due to the presence of significant mediastinal shift and apparent pleural air. Despite insertion of chest tube, the child’s condition did not improve, raising suspicion of alternative diagnosis. Careful observation of initial chest x-ray and subsequent chest ultrasound revealed a left sided congenital diaphragmatic hernia with herniation of stomach and intestine into thoracic cavity compressing the left lung and causing mediastinal shift. After the diagnosis of CDH was confirmed, the child was stabilized and emergent surgical repair performed. Postoperative recovery was uneventful, and the child was discharged with no significant long-term complications.ConclusionThis case underscores the importance of considering CDH in the differential diagnosis of acute respiratory distress in a child. It highlights the diagnostic challenges and potential risks of emergency interventions based on initial misdiagnosis. Even if x -ray looks like typical of tension pneumothorax, it showed giant cystic air filled structure pushing the mediastinal structure to contralateral side with loss of left diaphragmatic outline which raised suspicion of congenital cystic lung mass or congenital diaphragmatic hernia. Advanced imaging and high index of suspicion are crucial for accurate diagnosis and timely management, ultimately improving patient outcomes. Consideration of alternative diagnosis when our initial intervention with insertion of chest tube fail to provide symptom improvement in suspected pneumothorax should raise suspicion of congenital diaphragmatic hernia like in our case.

Stent-graft implantation for late postpancreatectomy hemorrhage after pancreatoduodenectomy

PurposePostpancreatectomy hemorrhage (PPH) is a life-threatening complication after pancreatoduodenectomy. Stent-graft implantation is an emerging treatment option for PPH. This study reports the outcome of PPH treated with stent-graft implantation. MethodsThis was a single-center, retrospective study. Between April 2020 and December 2023, 1723 pancreatectomy cases were collected while we screened 12 cases of PPH after pancreatoduodenectomy treated with stent-graft implantation. Patients’ medical and radiologic images were retrospectively reviewed. Technical and clinical success, complications, and stent-graft patency were evaluated. Continuous data are reported as means ± SD when normally distributed or as median (Q1, Q3) when the data is non-normal distributed. Categorical data are reported as n (%). A p value < 0.05 was considered statistically significant. Kaplan-Meier estimates were used for stent patency and patients’ survival. ResultsPancreatic fistula was identified in 6 cases (50.0%), and pseudoaneurysm was identified in 3 cases (25.0%), including pancreatic fistula together with pseudoaneurysm in 1 case (8.3%). All pseudoaneurysm or contrast extravasation sites were successfully excluded with patent distal perfusion, thus technical success was achieved in all cases. The overall survival rate at 6 months and 1 year was 91.7% and 78.6%, respectively. One patient had herniation of the small intestine into the thoracic cavity, which caused a broad thoracic and abdominal infection and died during hospitalization. Rebleeding occurred at the gastroduodenal artery stump in 1 case after stent-graft implantation for the splenic artery and was successfully treated with another stent-graft implantation. Two cases of asymptomatic stent-graft occlusion were observed at 24.6 and 26.3 after the operation, respectively. ConclusionsWith suitable anatomy, covered stent-graft implantation is an effective and safe treatment option for PPH with various bleeding sites and causes.

S4757 Generalized Peritonitis Induced by a Strangulated Right Amyand's Hernia Containing a Perforated Appendix: A Case Study

S4757 Generalized Peritonitis Induced by a Strangulated Right Amyand's Hernia Containing a Perforated Appendix: A Case Study

Assessing the Safety of Mesh Repair in Strangulated Groin Hernias: A Systematic Review and Meta-Analysis.

The use of mesh in emergency repair of complicated groin hernias has been a subject of discussion for decades. While it is now generally accepted that mesh could safely be used in incarcerated (irreducible) and obstructed hernias (without strangulation), with wound infection rates comparable to suture repairs, the use of mesh in strangulated hernias involving bowel resection is still controversial. The aim of this study, therefore, was to analyse the safety of mesh use in strangulated hernias with ischaemic bowel at the time of surgery.A literature search was carried out using relevant keywords. The study was conducted in accordance with the Preferred Reporting Items forSystematic Reviewsand Meta-Analyses (PRISMA) 2020 framework anddata analysis was done using the Review Manager version 5.4 (The Cochrane Collaboration, Oxford, UK) meta-analysis software.Seven studies comprising 1,159 patients who had emergency surgery for strangulated groin hernias were analysed. A pooled random effect meta-analysis did not show any significant difference in the surgical site infection rate (odds ratio (OR) = 0.88, 95% confidence interval (CI) = 0.39-1.96, p = 0.75), seroma formation (OR = 3.39; 95% CI = 0.70-16.43; p = 0.13), and hernia recurrence (OR = 0.33; CI = 0.05-2.22; p = 0.26) between the two groups. The long-held concern that mesh could not be safely used in strangulated groin hernias has not been validated by the results obtained from this systematic review and meta-analysis. However, more randomised controlled trials in this clinical area would need to be carried out to further validate the results of this study.

Single-Incision Laparoscopic Totally Extraperitoneal Sublay Repair of Lumbar Hernia: A Novel Technique.

Background: Lumbar hernia is a rare disease with low incidence, and no golden standard surgical procedure has been established for lumbar hernias. The single-incision laparoscopic totally extraperitoneal sublay (SIL-TES) technique became a novel surgical technique for lumbar hernias. Methods: This retrospective study included 20 patients who underwent SIL-TES repair for lumbar hernia between April 2020 and March 2024. The baseline patient characteristics, intraoperative data, postoperative data, satisfaction score, and Carolina Comfort Scale scores were collected. Results: The results revealed that the SIL-TES technique for lumbar hernia repair is associated with a low complication rate, nonrecurrence, high satisfaction score, and high quality of life after surgery. Conclusions: The SIL-TES technique could be a feasible and effective surgical technique for lumbar hernias. A controlled study is needed for further confirmation.

333. TECHNICAL CONSIDERATIONS IN UPPER-GI RECONSTRUCTION – A CASE SERIES

Abstract Background Oesophageal reconstruction post-oesophagectomy is performed for both benign and malignant pathologies. Generally, the stomach is the conduit of choice due to its simplicity, requiring only one anastomosis. However, in some cases the stomach may not be a viable option immediately or at all, and alternatives must be considered. We describe a case where the stomach was not immediately viable and two cases where alternative conduits were sought. Furthermore, we discuss techniques such as ‘supercharging’ and ‘superdrainage’ which enhance arterial flow and venous drainage respectively, in order to prevent ischaemia and related complications of the anastomosis site. Methods and Results Case 1 presents a 72-year-old with an incarcerated para-oesophageal hernia leading to necrosis of the distal oesophagus and proximal stomach. After resection, a feeding jejunostomy and a loop oesophagostomy in the neck was created. Months later, the oesophagostomy was closed, and the residual stomach was carefully mobilised into the thorax while preserving the gastro-epiploic arcade, and oesophago-gastric anastomosis was performed. Case 2 involves a 68-year-old female who had elective Nissen fundoplication for a hiatus hernia, which recurred early with strangulation of the distal oesophagus and proximal stomach requiring emergency oesophago-gastrectomy. She later underwent a colonic interposition using the left colon, with superdrainage through an anastomosis between a branch of the middle colic vein to the left external jugular vein. Case 3 describes a 61-year-old male with a gastro-oesophageal adenocarcinoma treated with an Ivor-Lewis oesophagectomy. A year later, he suffered from a strangulated diaphragmatic hernia causing necrosis of the gastric conduit. This was replaced with an isoperistaltic colonic interposition using the transverse and left colon with super drainage. Unfortunately, three years later, this was again complicated with pancreatitis and perforated gall bladder with associated ischaemia of the colonic conduit. A re-do of the colonic interposition using the right colon was done with an arterial graft between the right transverse cervical artery and branch of ileal artery and super drainage via a branch of the ileal and right external jugular veins. Conclusion Primary and in particular secondary re-constructions of the UGI tract are complex procedures and individual approaches are needed as residual anatomy varies. Consequently, such cases require meticulous planning and a multidisciplinary approach involving the cardio-thoracic, plastic and vascular surgeons and adequate support by the anaesthetic and intensive care team. Although associated with significant morbidity and mortality, reestablishment of a swallowing passage is often desired by patients to maintain quality of life.

Artefacts due to putrefactive gas production - an overview.

Autolytic and putrefactive processes can cause considerable alterations to soft tissues and internal organs that may complicate forensic assessments. An overview was undertaken of the range of taphonomonic changes and processes that may result from postmortem putrefactive gas accumulation. The most commonly encountered phenomenon was purging of putrefactive fluids from the nose and mouth that was on occasion confused with bleeding from antemortem trauma. Much less common was putrefactive 'rigor mortis' where the limbs extend due to the accumulation of soft tissue and subcutaneous gas. This may sometimes be associated with alteration of the position of a body suggesting that it had been deliberately moved. Distension and stretching of the skin and subcutaneous tissues may cause recently sutured surgical incisions to dehisce, raising the possibility of inflicted incised wounds. Raised intra-abdominal pressures may cause diaphragmatic herniation of small intestine and has been associated with so-called 'coffin birth' where a fetus is expelled from the uterus after death due to pressure on the fundus. Gas accumulation on postmortem computed tomography examination may be confused with air embolism or the effects of trauma. All of these changes are the result of anaerobic bacterial action generating gases such as methane, carbon dioxide and hydrogen sulphide resulting in pressure gradients.

A Case Report of Strangulated Small Bowel Spigelian Hernia and Literature Review

A Case Report of Strangulated Small Bowel Spigelian Hernia and Literature Review

A case of late-presenting congenital diaphragmatic hernia diagnosed at 5 years with acute abdomen

BackgroundSome congenital diaphragmatic hernias are diagnosed beyond 1 month. A late-presenting congenital diaphragmatic hernia shows a variety of clinical manifestations, and the preoperative clinical course is variable. We herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as acute abdomen.Case presentationA 5-year-old boy was brought to our hospital because of herniation of the intestine into the left thoracic cavity, which was observed on radiography performed for abdominal pain. Enhanced computed tomography showed herniation of the small intestine and colon into the left thoracic cavity. Emergency laparoscopic surgery was performed based on the diagnosis of left diaphragmatic hernia. The entire small intestine and part of the colon herniated from the posterolateral defect of the diaphragm. We were able to retract the herniated intestine back into the abdomen but confirmed that the diaphragmatic defect and closure of the defect seemed to be technically challenging via laparoscopy; therefore, we converted the procedure to open laparotomy. The diaphragmatic defect was directly closed with interrupted sutures, and the thoracic cavity was degassed. Postoperatively, the left lung was found to be poorly expanded, but pulmonary hypoplasia was not evident in this case.ConclusionsWe herein report a pediatric case of late-presenting congenital diaphragmatic hernia diagnosed as abdominal pain. Late-presenting congenital diaphragmatic hernias present with a wide variety of symptoms; therefore, it is important to be reminded of these conditions and check chest radiographs in children presenting with acute or chronic respiratory or gastrointestinal symptoms of unknown etiology.

282 Emergency Laparoscopic Parastomal Hernia Repair Around Ileal Coduit in a Morbidly Obese Patient - a Surgical Challenge Managed Successfully

Abstract Aim Management of a strangulated parastomal hernia (PH) around the ileal conduit can be a surgical challenge. We demonstrate here a safe and effective laparoscopic repair of a strangulated PH in the emergency setting for a 53year-old morbidly obese woman (BMI: 40). Method Entry to abdominal-cavity was by Veress-needle technique. PH defect was identified – containing strangulated part of ascending-colon that reduced spontaneously during creation of pneumoperitoneum. Adhesiolysis around stomal defect up to lateral attachment of ileal conduit was completed. 3cm defect was opposed using transfascial nonabsorbable sutures. 15cm circular-composite-mesh was fashioned U-shaped and introduced in medial to lateral direction with the U lips overlapped and fixed snug laterally around the ideal conduit. Mesh was further fixed through double-crown fixation. Results Patient had an uneventful recovery and discharged on the second post-operative day. A 10-month CT as a part of bladder cancer follow up showed no PH recurrence. Conclusions This case shows that strangulated PH around an ileal conduit, an uncommon presentation, can be successfully managed laparoscopically even in the emergency setting especially for patients of high BMI with proper assessment and appropriate expertise. Successful management of this challenging presentation of strangulated PH around ileal conduit demonstrates the safe and effective use of laparoscopic surgery especially in the emergency setting for patients of high BMI.

Obturator hernia: a persisting clinical diagnostic challenge – a case report

Introduction: The presentation of a strangulated obturator hernia is rare, with it accounting for less than 0.04% of all hernias. Delay in presentation and diagnosis results in complications like bowel ischemia, necrosis, perforation, and peritonitis, thereby increasing morbidity and mortality. Case presentation: The authors report the case of an 85-year-old multiparous woman who presented with a 3-day history of abdominal pain and vomiting. Upon examination, she exhibited hypotension, altered sensorium, and a distended abdomen with visible peristalsis. An abdominal pelvic computed tomography scan confirmed the diagnosis of ‘intestinal obstruction secondary to an incarcerated obturator hernia’. Subsequently, a lower midline laparotomy was performed, successfully reducing the bowel and repairing the hernial orifice. The patient was discharged on the fourth postoperative day, and there has been no hernia recurrence as of her 3-month follow-up. Discussion: The presentation of a strangulated obturator hernia can be elusive. During clinical examination, both the Howship–Romberg sign and the Hannington-Kiffs sign tests may be negative. Laparoscopic obturator hernia repair has been shown to reduce hospital stay and morbidity. A midline laparotomy has the advantage of easy manual reduction, minimizing bowel trauma, accurately accessing the bowel, and facilitating bowel resection. Conclusion: Obturator hernias constitute rare subtypes of abdominal hernias. They typically occur in older women, and patients often present with poor functional status and multiple comorbidities. The clinical diagnostic tests are uncertain, even in patients with a high index of suspicion. Timely diagnosis and appropriate surgical management are crucial for a favorable outcome.

Specific Features of Diagnostic and Treatment Tactics in Patients with Crushed Abdominal Hernias Without Resection of a Hollow Organ.

The purpose of the work is to analyze the results of the use of optimized diagnostic and therapeutic tactics in patients with strangulated abdominal hernias without resection of the hollow organ. Materials and methods: The work is based on the analysis of the results of surgical treatment of 665 patients with strangulated abdominal hernias without resection of the hollow organ, who were divided into 2 groups depending on the features of the diagnostic and treatment tactics. Unlike the patients of group 1, the following diagnostic tactics were used in group 2: substantiated laparoscopic diagnosis of abdominal organs; mandatory biochemical assessment of hernia water; mandatory intraoperative instrumental assessment of the state of the strangulated organ; expansion of indications for the use of laparoscopic interventions and components of the comprehensive Fast track program; substantiated complex prevention of malignancy. The clinical diagnostic algorithm included laboratory, instrumental and biochemical research methods. Results: The use of priority diagnostic and therapeutic tactics in the patients of group 2 allowed to increase the number of laparoscopic hernioplasty by 49.34%, the number of allohernioplasty by 18.62%, among which the "Sublay" technique was preferred for strangulated ventral hernias. This was accompanied by a decrease in the pain syndrome on the VAS scale during the four days of observation, both during coughing and at rest, and amounted to only 2.21 ± 0.29 points on the fourth day when at rest. In addition, and after 12 months, the patients of group 2 observed a better recovery according to the SF-36 questionnaire, which amounted to 76.77±6.63 points for the assessment of the general state of health, 70.81±5.86 points for the assessment of physical functioning, 68.88±5.37 points for the assessment of role functioning due to physical condition, 68.03±5.92 points for the assessment of role functioning due to emotional state, and social activity was characterized by 72.82±5.52 points. Conclusions: 1. The proposed diagnostic and treatment tactics in the patients of group 2 with strangulated abdominal hernias without resection of a hollow organ, in contrast to patients in group 1, made it possible to increase the number of laparoscopic operations to 227 (66.37%) in contrast to 55 (17.03%) in the first group, which was accompanied by a decrease in pain syndrome on the VAS scale on the fourth day when coughing from 4.35 ± 0.38 points to 2.97 ± 0.43 points. 2. The expansion of indications for the use of laparoscopic operations in patients of group 2, in contrast to patients of group 1, led to a decrease in the postoperative complications by 10.48% and the postoperative mortality by 2.29% and was characterized by better postoperative rehabilitation according to the assessment of the patients' condition after 12 months according to the SF-36 questionnaire..

OPTIMIZING THERAPEUTIC APPROACH FOR EFFECTIVE MANAGEMENT OF EMERGENCY STRANGULATED INGUINAL HERNIA

Abstract Background Inguinal hernias are a frequent reason for emergency settings. Incarcerated cases carry significant risk of strangulation. The approach to emergency treatment depends on the patient’s and environment conditions. However, the utilization of prosthetics in strangulated hernia treatment is constrained by concerns surrounding complications in a septic environment and the urgent situation. A prospective observational study was followed. Objective The aim of this study is to determine whether the utilisation of prothesis in managing strangulated hernias correlates with an elevated incidence of post operative events. Methods A total of 223 patients with a strangulated inguinal hernia who underwent surgical intervention. Inclusion criteria encompassed patients aged 15 years and above, admitted on an emergency basis with a strangulated hernia, and categorized as Asa III or lower. Results All admitted patients presented with a strangulated inguinal hernia. The average age was 55 years. Occlusive syndrome occurred in 17% of cases. The contents of the hernia sac varied, with 70% being non suffering, 19% containing epiploic content, 6% colonic, and 5% requiring anastomosis resection due to intestinal suffering. Among 223 patients who underwent hernioplasty using the Lichtenstein procedure, the mortality rate was 0.9%, and the morbidity rate reached 17%. parietal sepsis accounted for 6.72 %, serum related issue for 5.82%, and hematomas for 4.48%, with no reported instances of prosthesis removed. Conclusion In light of the result of this study, the consideration to utilize a prosthesis in emergency hernia situations warrants careful evaluation, taking into account therapeutic criteria and prevailing conditions.

LUMBAR INCISIONAL HERNIA REPAIR-PREPERITONEAL PLACING OF MESH-THE IMPORTANCE OF CT EVALUATION

Abstract Background Lumbar hernias can be congenital (primary) or aquired (postoperative and posttraumatic). The margins are well-known: the iliac crest, 12th rib, the erector spinae and the external oblique muscle. The most number of lumbar incisional hernias occur after nephrectomy. Objective To show the results in treatment of lumbar incisional hernias in district General hospital and to review the importance of CT evaluation before and after treatment of lumbar incisional hernias (specially for W3 = the width of hernia defect ≥ 10 cm ≈ large hernias). Methods This is retrospective case-study analysis from June 2005 till November 2021.The mean follow-up for all patients was 36 months. Results From 15 June 2005. to 15 November 2021 we operated 18 patients with diagnosis: Lumbar incisional hernia. 16 patients were operated due to principles of sublay-preperitoneal placing of MESH (all by the same surgeon). In our evaluation we divided the patients in 3 groups according to the width (size) of hernia defect – W1, W2 and W3. For the patients with “large hernias” (W3) – 5 patients, we perform CT of abdomen 3 times (before operation, a few months after operation and 2 or 3 years after operation). All other patients have CT of abdomen before operation-only certain proof for diagnosis. We do not have recurrences and none of our patients need analgetics more than two weeks after surgery. Laparoscopic incisional hernia surgery is not performed routine in our hospital yet. Conclusion Lumbar incisional hernias should be treated with sublay (preperitoneal placing of MESH) whenever is possible. CT evaluation before and after surgery is always usefull for large hernias, with big level of recommendence.

Tubular vs. mini-open lumbar discoidectomy: surgical-clinical outcome.

To evaluate the clinical-surgical results of the tubular vs. mini-open approach in lumbar discoidectomy. The tubular approach promises to reduce the number of rest days and an earlier return to daily activities and work. A case-control study of patients operated on for disc herniation using tubular surgery (case) and mini-open (control) was carried out. The variables investigated were as follow: radicular and lumbar pain, sex, age, failure in conservative treatment, single-level lumbar hernia, surgical time, bleeding, length of hospital stay, persistence of symptoms, complications, occupational activity, and reintegration into everyday activities. Through 100 surgeries performed, two groups were created, tubular and mini-open, with 50 patients each, with L4-L5 or L5-S1 disc herniation, respectively. The most affected level was L4-L5 (69%). Of the total cases, a significant improvement was found (p < 0.05) at 15 postoperative days in the VAS and ODI scale in the tubular group with respect to mini-open. Complications such as surgical wound infection, durotomy, and persistent pain occurred. The tubular approach is a safe and effective option for herniated discs of the lumbar segment, and reduces surgical times, bleeding, and the time of reinsertion to daily activities of the patient.

A Rare Case of Perforated Caecal Cancer Disguised as a Strangulated Right Inguinoscrotal Hernia

A Rare Case of Perforated Caecal Cancer Disguised as a Strangulated Right Inguinoscrotal Hernia