Asymptomatic portal vein aneurysms: To treat, or not to treat?

Background Portal vein aneurysms are rare dilations in the portal venous system, for which the etiology and pathophysiological consequences are poorly understood. Method We reviewed the existing literature as well as present a unique anecdotal case of a patient presenting with a very large portal vein aneurysm that was successfully managed conservatively and non-operatively without anticoagulation, with close follow-up and routine surveillance. Result The rising prevalence of abdominal imaging in clinical practice has increased rates of portal vein aneurysm detection.

Adrenocortical Carcinoma: Complete Surgical Resection After 18 Years.

Adrenal cortical carcinoma (ACC) is a rare neoplasm often associated with an aggressive biological behavior. Complete surgical resection is the mainstay of therapy for ACC and offers the best chance for prolonged disease-free survival. We present an unusual case of a long-standing adrenal mass, well documented over a period of at least 18 years, without the development of metastatic disease, and ultimately proven to represent ACC after successful surgical resection.

Laparoscopic surgery for inflammatory bowel disease.

Laparoscopic surgery has recently been gaining acceptance as an alternative approach for patients with inflammatory bowel disease. There is increasing evidence demonstrating the multiple potential benefits of laparoscopy including faster recovery, reduced costs, and lower morbidity. For patients with acute colitis, a laparoscopic subtotal colectomy and end ileostomy have been shown to be feasible and safe in experienced hands.

Incontinence after a lateral internal sphincterotomy: are we underestimating it?

Purpose: This study was designed to assess the long-term outcomes and quality of life of patients who have undergone a sphincterotomy for chronic anal fissure.

Methods: The medical records of patients who underwent this operation between 1992 and 2001 were reviewed. A questionnaire was mailed to assess their current status, along with the Fecal Incontinence Quality of Life and Fecal Incontinence Severity Index surveys.

Is laparoscopic colectomy applicable to patients with body mass index >30? A case-matched comparative study with open colectomy.

Purpose: The benefits of early postoperative recovery, reduced postoperative pain, pulmonary dysfunction, and hospitalization after laparoscopic colectomy may improve outcome over open colectomy in obese patients. This case-matched study compares outcomes after open and laparoscopic colectomy.

Methods: A total of 94 laparoscopic colectomy patients with a body mass index >30 (Jan 1999-June 2003) were identified from a prospective database and matched to open colectomy cases for age, gender, body mass index, American Society of Anesthesiologists class, procedure, indication, and date of surgery.

Does conversion of a laparoscopic colectomy adversely affect patient outcome?

Purpose: Conversion during laparoscopic colectomy varies in frequency according to the surgeon's experience and case selection. However, there remains concern that conversion is associated with increased morbidity and higher hospital costs.

Methods: From January 1999 to August 2002, 430 laparoscopic colectomies were performed by two surgeons, with 51 (12 percent) cases converted to open surgery.

Aortic thrombosis after low anterior resection for rectal cancer: report of a case.

Pelvic surgery for malignant disease has been associated with numerous acute postoperative complications. These complications are primarily vascular or neurologic in origin. Several factors associated with the occurrence of these complications include the lithotomy position, the prolonged use of sequential compression devices, the use of certain types of stirrups, the presence of peripheral vascular disease, and the common hypercoagulable state of most cancer patients.