The current decade has witnessed the evolution of Minimal Access Surgery (MAS) from Multi port Laparoscopy to Single Port Laparoscopy. The reduction of ports, subsequent scars and pain makes MAS more patients friendly. Symptomatic Subxiphoid Incisional hernias in patients having post CABG Sternotomy are surgically challenging. This is because of the difficult anatomical position i.e. sternum and the ribs superiorly and the diaphragm posteriorly. Another reason is high intra-abdominal pressure with the shearing forces of the musculature in the upper abdomen. Consequently the conventional open primary anatomical or mesh repairs are difficult to perform and have a high recurrence rate. Laparoscopy promises to be an effective technique to treat this condition. In this case report we describe the use of Laparoscopy in particular: Single Incision for the repair of CABG Sternotomy Subxiphoid Hernia along with relevant literature. This is the first report in English Language Literature.
Pulmonary hydatid is not a rare disease. But raising a suspicion for its diagnosis is limited. There are limited approaches for the diagnosis and treatment of the same. We present here four cases of pulmonary hydatid, without liver involvement, with emphasis on how it was misdiagnosed and received multiple treatment and landed into complications. Most of our cases presented with cough, sputum and hemoptysis. For these nonspecific signs and symptoms, patient is generally treated on a different line of diagnosis. Two of the cases were already treated for abscess and fungal infection. One of the patients was on antitubercular treatment. One of our cases was secondarily infected with aspergilloma. One of the cases was referred to oncologist to start chemotherapy. Interestingly, to raise a suspicion, none of our cases had liver involvement. A detailed history revealed expectoration of white salty material in sputum, living with sheep and dog and expectorating grape-like vesicles in sputum. History helped us to put hydatid as one of our differentials. Echinococcal serology was positive in three cases. Only three cases had on-table appearance of hydatid cyst. All four cases underwent surgical management for complete cure. There is need for strong suspicion and a detailed history and proper set of investigations help in timely diagnosis and management of pulmonary hydatid disease.
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