Surgical training in the Caribbean: The past, the present, and the future.

The six million inhabitants of these diverse English-speaking Caribbean countries are grateful to the University of the West Indies, which has been central in the independent training of surgical specialists in all areas of surgery for the past 50 years. Similar to the per capita income, the quality of surgical care, albeit acceptable, is quite variable throughout the region. Globalization and access to information have revealed that the quality of training and surgical care being delivered can be further improved.

Laparoscopic adrenalectomy for a giant adrenal teratoma: A case report and review of the literature.

Introduction And Importance: Teratomas typically are benign gonadal neoplasms, arising from more than one embryonic germ layer. Extragonadal teratomas are rare and primary adrenal teratomas more so, with few documented cases. We present one such case, diagnosed via CT, resected via laparoscopic adrenalectomy, and confirmed on histology.

Discordant intestinal malrotation in adult monozygotic twins discovered incidentally during laparoscopic gastric bypass: A case report and review of the literature.

Introduction And Importance: Intestinal Malrotation is an uncommon entity in the adult population; more so in monozygotic twins, where concordance is expected. In literature, discordant intestinal Malrotation has only been discovered when one twin became symptomatic, and the other was screened. To the best of our knowledge, this is the first documented case of discordant adult type intestinal Malrotation in otherwise asymptomatic monozygotic twins discovered incidentally during Laparoscopic Roux-en-Y Gastric bypass (LRYGB).

Retroperitoneal liposarcoma mimicking pheochromocytoma.

Retroperitoneal liposarcomas are rare mesenchymal tumors which carry a poor prognosis because of their late presentation. When symptoms do occur, they are usually nonspecific and related to mass effect or invasion of local structures. Rarely, retroperitoneal liposarcomas can clinically and biochemically mimic phaeochromocytomas.

Choledochal cyst mimicker-When small bowel length matters.

Objective: Due to the risk of malignancy, the established management of choledochal cysts mandates bile duct excision and biliary reconstruction. While the reconstructive procedure of choice for most surgeons has traditionally been hepatico-jejunostomy, this may not be feasible in selected cases due to immobility or inadequacy of the jejunum. The following case will outline the management of a 32-year-old woman with short bowel syndrome, who was diagnosed with choledocholithiasis and a type 1 choledochal cyst.

Surgical glove use for specimen removal in laparoscopy, the cheapest available: a prospective study.

Despite the proven benefits of laparoscopic surgery, it is indeed very costly. The aim of our study was to show an effective way to reduce one of the costs. Between January 2012 and December 2018, we used sterile unpowdered latex-free surgical gloves for specimen retrieval in 243 selected cases of laparoscopic cholecystectomy and appendectomy.

A case report of the clear cell variant of gallbladder carcinoma.

Introduction: Clear cell gallbladder carcinoma accounts for less than 1% of all gallbladder malignancies and demonstrates its unique histopathological characteristics in patients with no prior medical illness or familial predisposition.

Presentation Of Case: Here we present a case of a 56-year-old female, with no prior medical conditions presented with a 2-month history of upper abdominal pain. Routine hematological and biochemical tests were unremarkable.

Synchronous volvulus of the sigmoid colon and caecum, a very rare cause of large bowel obstruction.

Colonic volvulus usually occurs as a single event that can affect various parts of the colon. The usual sites affected being the sigmoid colon (75%) and the caecum (22%). The phenomenon of multiple sites simultaneously undergoing volvulus is an extremely rare occurrence.

Volvulus of ileum: a rare cause of small bowel obstruction.

Small bowel volvulus is a rare but life-threatening surgical emergency. Owing to its rarity, it is seldom entertained as a differential for small bowel obstruction. The aetiology may be either primary or secondary, with secondary being more common in the Western world.

Laparoscopic repair of a rare acquired abdominal intercostal hernia.

Introduction: An acquired abdominal intercostal hernia (AIH) is a very rare and sporadically reported entity. Most cases of AIH are secondary to major trauma and the treatment of choice is surgical repair.

Presentation Of Case: We present the case of a 58-year-old man who presented with a painless intercostal swelling, which started after previous penetrating trauma to the same area.

Clinical outcomes of single incision laparoscopic cholecystectomy in the anglophone Caribbean: a multi centre audit of regional hospitals.

Introduction: There has been no report on Single-Incision Laparoscopic Surgery (SILS) cholecystectomy outcomes since it was first performed in the Anglophone Caribbean in 2009.

Methods: A retrospective audit evaluated the clinical outcomes of SILS cholecystectomies at regional hospitals in the 17 Anglophone Caribbean countries. Any cholecystectomy using a laparoscopic approach in which all instruments were passed through one access incision was considered a SILS cholecystectomy.

Complicated acute appendicitis? An unusual differential.

Acute appendicitis is a common surgical diagnosis but several differential diagnoses exist and should be considered. Internal concealment is one such diagnosis. We present a case of a young man taken to the operating room with a preoperative diagnosis of complicated acute appendicitis.

Solid pseudopapillary neoplasms of the pancreas: a report of two cases.

Solid pseudopapillary neoplasms of the pancreas are uncommon, accounting for only 1-2% of all pancreatic neoplasms. These tumors are being detected at an increased rate, probably due to the increased awareness and the liberal use of imaging. We report two cases of patients with solid pseudopapillary pancreatic tumors and review the existing literature.

Laparoscopic Repair of Sportman's Hernia - The Trinidad Experience.

Sportman's hernia: (Athletic pubalgia) is an uncommon and poorly understood condition afflicting athletic individuals. Sufferers complain of chronic groin pain and often present diagnostic dilemmas to physicians and physiotherapists. We present a series of cases illustrating the varying presentations of sportman's hernia and diagnostic approaches that can be utilized to exclude common differentials.

Anatomic and clinical rationale of the V-sign to detect accessory axillary breast tissue.

The potential for breast cancer to present with lymphatic metastases, has instilled anxiety when women present with axillary masses. We discuss a simple and reliable clinical sign that can help clinicians to distinguish between axillary nodal metastases and accessory axillary breast tissue. Awareness and recognition of the "V-sign" can allay anxiety in women with accessary axillary breast tissue and prevent costly investigations in most cases.

Retrograde thyroidectomy: a technique for visualization and preservation of the external branch of superior laryngeal nerve.

Introduction: The external branch of the superior laryngeal nerve (EBSLN) should be identified during thyroidectomy to prevent injury and post-operative voice change. Identification is rendered difficult during a standard thyroidectomy where there is a large gland with upper pole enlargement. We describe the retrograde thyroidectomy technique to facilitate nerve preservation.

Inguinal hernia and airport scanners: an emerging indication for repair?

The use of advanced imaging technology at international airports is increasing in popularity as a corollary to heightened security concerns across the globe. Operators of airport scanners should be educated about common medical disorders such as inguinal herniae in order to avoid unnecessary harassment of travelers since they will encounter these with increasing frequency.

Preoperative digital carotid compression as a predictor of the need for shunting during carotid endarterectomy.

This study prospectively attempted to assess the need for shunting by preoperative digital compression of the proximal common carotid artery and correlated these findings with intraoperative assessment while performing carotid endarterectomy under local anaesthesia. Preoperative digital compression is highly predictive of the need for shunting intra-operatively and can be used as a valuable test in carefully chosen patients. This may help in decreasing the need for advanced neurological monitoring during carotid endarterectomy.

Isolated endometriosis causing sigmoid colon obstruction: A case report.

Introduction: Isolated endometriosis of the intestine causing large bowel obstruction is rare.

Presentation Of Case: We present a case of endometriosis presenting as large bowel obstruction in a woman of childbearing age. She had no previous symptoms to suggest endometriosis and on presentation urgent surgery was required.

Cervical leverage: A new procedure to deliver deep retrosternal goitres without thoracotomy.

Introduction: Although most retrosternal goitres can be removed through a standard collar incision, some cases require extra-cervical incisions for complete resection. We report a new technique to remove large retrosternal goitres without extra-cervical incisions.

Presentation Of Case: We present two cases in which a US Army-Navy (Parker-Langenback) retractor was used to deliver large retrosternal components into the cervical incisions.

Laparoscopic resection of a retroperitoneal myolipoma presenting in a right inguinal hernia.

Introduction: Myolipoma of soft tissue is an extremely rare benign lipomatous lesion. The lesions are most commonly located in the abdominal cavity, retroperitoneum, and inguinal areas. Despite their large size, myolipomas are cured by surgical resection.