AbstractGarengeot’s hernia (GH) is defined as the presence of the appendix inside a femoral hernia. It occurs in 0.9% of femoral hernias and is usually an incidental finding during surgery. Its treatment is controversial and the aim of this article is to review the diagnostic methods and surgical considerations.We report two cases diagnosed preoperatively by contrast-enhanced computed tomography (CT) and discuss the treatment options based on a review of the literature published in PubMed updated on 1 December, 2015.Fifty articles reporting 64 patients (50 women, mean age 70 years) with GH were included in the analysis. Diagnosis was performed by preoperative CT in only 24 cases, including our two. The treatment of GH is emergency surgery. Several options are available laparoscopic or open approach: insertion of a mesh or simple herniorrhaphy, with or without appendectomy.ConslusionThe preoperative diagnosis with CT can guide the choice of treatment. Appendectomy and hernioplasty should be performed via inguinotomy, if there is no perforation or abscess formation.

On the basis of the literature available at present, we cannot recommend the use of wrapping with omentum and/or FL in pancreatic surgery. Prospective randomized studies applying a systematic wrapping technique are needed in order to establish whether its use should be generalized.

This study compares the behavior of several cross- and noncrosslinked biomeshes (Permacol®, CollaMend®, Surgisis®, Tutomesh®, and Strattice®) currently used for abdominal wall repair when implanted intraperitoneally and extraperitoneally. Material and Methods. Intraperitoneal (IP) implants were fixed on the parietal peritoneum and partial abdominal wall defects (EP) were repaired using each of the biomeshes, in the rabbit abdominal wall. After 90 days of implant, the biomeshes were examined to assess biomesh degradation, collagen I and III expression (Sirius red staining) and the host macrophage response (immunohistochemistry). Results. Following implant, the thinner noncrosslinked biomeshes Tutomesh and Surgisis, were almost fully degraded in both models. In contrast, Strattice behavior was similar to crosslinked biomeshes, showing negligible degree of degradation. This mesh also showed high expression of collagen I, similar to the crosslinked. The noncrosslinked materials elicited lower macrophage counts, significantly so for Strattice. In IP and EP models, Permacol showed similarly high macrophages while counts were lower for CollaMend and Surgisis in the EP model. Conclusions. The intra or extraperitoneal implant of the different meshes did not affect host tissue incorporation or mesh degradation. The crosslinked biomeshes induced a more intense macrophage response regardless of their IP or EP location.

AIMTo delay surgery until the patient is in a better condition, and thus to decrease postoperative morbidity.METHODSUsing this algorithm we treated three patients aged 55, 75 and 80 years. In all three patients the clinical presentation was fever without a clear source of infection; all had nonspecific symptoms such as general malaise, dyspnea, and abdominal discomfort in the previous 15 d. They came to the emergency room at our hospital due to deterioration of their general condition. Analytical tests showed leukocytosis, neutrophilia and increased polymerase chain reaction. In all cases an abdominal computed tomography (CT) was performed and liver hydatid abscess (LHA) was detected. The mean size of the LHA was 12 cm.RESULTSAll patients underwent CT-guided percutaneous drainage. The purulent material obtained was cultured, and Klebsiella pneumoniae, Streptococcus viridans and Streptococcus salivarius were identified. Antibiotic treatment was given adapted to antibiotic sensitivity testing. Surgery was performed two weeks after admission, once the patient’s condition had improved. All three patients underwent an almost total cystectomy, cholecystectomy and omentoplasty in the residual cavity. Complications were: Clavien I (atelectasis and pleural effusion) and Clavien II (transfusion). The average length of stay (pre and postoperative) was 23 d. At the follow-up, no relapses were recorded.CONCLUSIONLHA management is not standardized. Emergency surgery offers suboptimal results. Percutaneous drainage plus antibiotics allows improving patient’s general condition. This enables treating patients in greater safety and also reduces complications.