Barium Enema for Treatment for Diverticular Bleeding.

Diverticula of the colon are the most common cause of lower gastrointestinal bleeding in adults. In cases of persistent loss of blood or severe acute hemorrhage, treatment is required. However, if these modern intervention techniques are inadequate, surgical resection of the colon may be required.

Mesh versus suture repair of umbilical hernia in adults: a randomised, double-blind, controlled, multicentre trial.

Background: Both mesh and suture repair are used for the treatment of umbilical hernias, but for smaller umbilical hernias (diameter 1-4 cm) there is little evidence whether mesh repair would be beneficial. In this study we aimed to investigate whether use of a mesh was better in reducing recurrence compared with suture repair for smaller umbilical hernias.

Methods: We did a randomised, double-blind, controlled multicentre trial in 12 hospitals (nine in the Netherlands, two in Germany, and one in Italy).

Prophylactic Mesh Placement During Formation of an End-colostomy Reduces the Rate of Parastomal Hernia: Short-term Results of the Dutch PREVENT-trial.

Objective: The aim of this study was to investigate the incidence of parastomal hernias (PSHs) after end-colostomy formation using a polypropylene mesh in a randomized controlled trial versus conventional colostomy formation.

Background: A PSH is the most frequent complication after stoma formation. Symptoms may range from mild abdominal pain to life-threatening obstruction and strangulation.

Prophylactic mesh placement to prevent parastomal hernia, early results of a prospective multicentre randomized trial.

Purpose: Parastomal hernia (PSH) is a common complication after colostomy formation. Recent studies indicate that mesh implantation during formation of a colostomy might prevent a PSH. To determine if placement of a retromuscular mesh at the colostomy site is a feasible, safe and effective procedure in preventing a parastomal hernia, we performed a multicentre randomized controlled trial in 11 large teaching hospitals and three university centres in The Netherlands.

Consequence of restaging after neoadjuvant treatment for locally advanced rectal cancer.

Background: Locally advanced rectal cancer is customarily treated with neoadjuvant chemoradiotherapy (CRT) followed by a total mesorectal excision. During the course of CRT, previously non-detectable distant metastases can appear. Therefore, a restaging CT scan of the chest and abdomen was performed prior to surgery.

[Elastofibroma dorsi: a characteristic, benign, subscapular swelling].

Two female patients, 63 and 67 years old, visited the outpatient department with a growing soft tissue swelling bilaterally in the subscapular region. Using CT imaging and core needle biopsy, the first patient was diagnosed with an 'elastofibroma dorsi'. Because of the benign character of this lesion an expectative policy was followed.

Feasibility study of three-nerve-recognizing Lichtenstein procedure for inguinal hernia.

Background: Inguinal nerve identification during open inguinal hernia repair is associated with less chronic postoperative pain. However, most Dutch surgeons do not identify all three inguinal nerves when carrying out this procedure. The aim of this study was to evaluate the feasibility of a nerve-recognizing Lichtenstein hernia repair and to measure the extra time required for surgery

Methods: Forty patients with primary inguinal hernia were operated on following the nerve-recognizing Lichtenstein hernia repair by four experienced hernia surgeons from four different Dutch teaching hospitals.

An early observation on the anatomy of the inguinal canal and the etiology of inguinal hernias by Petrus Camper in the 18th century.

The famous Dutch medical doctor Petrus Camper (1722-1789) was appointed professor of anatomy and surgery at the University of Franeker, Amsterdam, and Groningen. As Praelector Anatomiae of the Amsterdam Guild of Surgeons, he gave public anatomy lessons in the Anatomy theatre in Amsterdam. During the mid 18th century he performed dissections on corpses of children and adults to investigate the anatomy and etiology of inguinal hernias.

Bilateral round ligament varicosities mimicking inguinal hernia during pregnancy.

Round ligament varicosities during pregnancy have not been reported extensively. The swelling mimics an inguinal hernia and should be considered in the differential diagnosis of a groin swelling during pregnancy. We report a case of a pregnant woman with bilateral round ligament varicosities.

Nerve-identifying inguinal hernia repair: a surgical anatomical study.

Background: Pain syndromes of somatic and neuropathic origin are considered to be the main causes of chronic pain after open inguinal hernia repair. Nerve-identification during open hernia repair is suggested to be associated with less postoperative chronic pain. The aim of this study was to define clinically relevant surgical anatomical zones facilitating efficient identification of the three inguinal nerves during open herniorrhaphy.

Surgical techniques preventing chronic pain after Lichtenstein hernia repair: state-of-the-art vs daily practice in the Netherlands.

Background: Morbidity associated with open inguinal hernia repair (IH repair) mainly consists of chronic pain. The aim of this study was to identify possible disparities between state-of-the-art Lichtenstein repair, and its application in general practice.

Methods: A questionnaire was mailed to all surgeons and surgical residents (n = 1,374) in the Netherlands in February 2005.

[Quality of a non-subsidised multicentre randomised trial in non-academic hospitals; an audit].

Objective: To determine whether a randomised clinical trial in general hospitals can be performed in a reliable way without financial support.

Design: Descriptive.

Method: The trial involved 1040 patients in whom an inguinal hernia had been corrected with a propylene mat in the period 1998-2003.

Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery.

Purpose: Mechanical bowel preparation is common practice in elective colon surgery. In recent literature the value of this procedure is under discussion. To verify the value of mechanical bowel preparation in elective open colon surgery, a randomized clinical trial was conducted.

The role of antibiotic prophylaxis in prevention of wound infection after Lichtenstein open mesh repair of primary inguinal hernia: a multicenter double-blind randomized controlled trial.

Objective: To determine whether the use of prophylactic antibiotics is effective in the prevention of postoperative wound infection after Lichtenstein open mesh inguinal hernia repair.

Summary Background Data: A recent Cochrane meta-analysis (2003) concluded that "antibiotic prophylaxis for elective inguinal hernia repair cannot be firmly recommended or discarded."

Methods: Patients with a primary inguinal hernia scheduled for Lichtenstein repair were randomized to a preoperative single dose of 1.

Surgical treatment options for carpal tunnel syndrome.

Background: Carpal tunnel syndrome is a common disorder, for which several surgical treatment options are available.

Objectives: To compare the efficacy of the various surgical techniques in relieving symptoms and promoting return to work and/or activities of daily living and to compare the occurrence of side-effects and complications, in patients suffering from carpal tunnel syndrome.

Search Strategy: We updated the searches in 2003.

18F-2-fluoro-2-deoxy-d-glucose positron emission tomography in staging of locally advanced breast cancer.

Purpose: To prospectively evaluate the effect of adding whole-body (18)F-2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) to conventional screening for distant metastases in patients with locally advanced breast cancer (LABC).

Patients And Methods: All women with LABC referred for participation in the LABC Spinoza trial were considered eligible for this study. Patients were included if chest x-ray, bone scan, liver ultrasound, or computed tomography scan performed by the referring physician failed to reveal distant metastases.

Feasibility of early closure of loop ileostomies: a pilot study.

Purpose: A loop ileostomy is constructed to protect a distal anastomosis, and closure is usually performed not earlier than after two to three months. Earlier closure might reduce stoma-related morbidity, improve quality of life, and still effectively protect the distal anastomosis. This pilot study was designed to investigate the feasibility of early closure of loop ileostomies, i.

[The 'Inguinal Hernia' guideline of the Association of Surgeons of the Netherlands].

The 'Inguinal hernia' guideline was written over a period of two years by nine surgeons (including one epidemiologist) from all regions of the Netherlands with demonstrable clinical and scientific expertise in the area of inguinal surgery after a training course on 'The development of evidence-based guidelines'. A draft of the guideline was on the website of the Association of Surgeons of the Netherlands for a period of three months, during which time the members of the society could comment on its contents interactively. The guideline comprises chapters on risk factors and prevention, diagnostics, indications for treatment, treatment, day surgery, antibiotics, thrombosis prophylaxis, training, anaesthesia, postoperative pain control, complications, costs, aftercare, and specific aspects of inguinal hernia in children.

Repair of large midline incisional hernias with polypropylene mesh: comparison of three operative techniques.

Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay.

Surgical treatment options for carpal tunnel syndrome.

Background: Carpal tunnel syndrome is a common disorder, for which several surgical treatment options are available. However, there is no consensus on the most effective method of treatment.

Objectives: To compare the efficacy of the various surgical techniques in relieving symptoms and promoting return to work and/or activities of daily living and to compare the occurrence of side-effects and complications in patients suffering from carpal tunnel syndrome.