BACKGROUND:Giant pulmonary hydatid cysts (GHCs), defined as cysts measuring ≥10 cm, pose significant surgical challenges owing to their large size and distortion of the native lung architecture, which often limits the effectiveness of conventional capitonnage. This study evaluates the feasibility and early clinical outcomes of a novel closed-book parenchyma-sparing technique designed to achieve complete residual cavity obliteration while preserving functional lung parenchyma. METHODS:A retrospective analysis was performed on 12 consecutive patients with GHCs who underwent surgery between September 2022 and August 2025. Diagnosis was confirmed by contrast-enhanced computed tomography. The closed-book technique involved controlled cyst evacuation, meticulous bronchial closure, and symmetrical bidirectional intracystic plication. Patients were followed for 15 months to assess postoperative complications, lung re-expansion, and recurrence. RESULTS:The mean patient age was 33.4 years, with female predominance (75%). Cyst size ranged from 11 to 16 cm (mean 13.5 cm), most commonly involving the right lower lobe and left upper lobe. Four patients presented with ruptured cysts. The technique achieved complete lung re-expansion in all cases. No postoperative air leaks, empyema, atelectasis, surgical site infection, residual cavity, recurrence, or mortality were observed during the 15-month follow-up. One patient developed a transient pleural effusion that resolved spontaneously. The mean hospital stay was 12.9 days. CONCLUSION:The closed-book parenchyma-sparing technique is a feasible and promising lung-preserving approach for GHCs. Larger prospective comparative studies are warranted to validate its safety, reproducibility, and long-term effectiveness.Abbreviations: CECT; contrast-enhanced computed tomography; GHCs: giant pulmonary hydatid cysts.
BACKGROUND:Historical descriptions of mandibular fracture treatment inform the evolution of maxillofacial surgery. Ālī ibn Ābbas al-Mājūsī's Kāmil al-Ṣinā'at al-Ṭibbīyah includes practical maneuvers for mandibular fractures not widely summarized in modern literature. METHOD:This is a textual and interpretive analysis of Kāmil al-Ṣinā'at al-Ṭibbīyah by Ālī ibn Ābbas al-Mājūsī, focusing on the chapter devoted exclusively to the management of mandibular fractures. To conduct this research, a version of the author's original language (Arabic) was used, and finally, to clarify the proposed maneuvers in the treatment of Mandibular fracture, interpretive anatomical reconstruction was performed using craniofacial moulage models and detailed images were recorded by the authors. The recommended medications, therapeutic and post-therapeutic measures were accurately extracted from the source under study and categorized in specific tables. RESULT:Close reading of al-Mājūsī's surgical chapter reveals two principal maneuvers: closed realignment for non-displaced fractures and transcutaneous/head-wrap traction with dental wiring or silk fixation for displaced fractures. Post-reduction care (immobilization, diet, topical compresses) and an asserted ∼20-day healing period are described; specific medicinal applications to reduce swelling are listed. CONCLUSIONS:Al-Mājūsī's techniques show continuity with earlier Greco-Roman practices and offer historical insight into non-invasive fracture management and immobilization methods relevant for understanding the roots of modern mandibular trauma care.
INTRODUCTION:Rectovaginal fistulae resulting from rectal surgery for cancer, especially in the irradiated field, represent a difficult situation for colorectal surgeons. To avoid radical and mutilating solutions and to limit morbidity, several therapeutic approaches have been described, but no consensus has yet been established. Omental and pedicled muscular flaps interpositioned between the rectum and vagina offer good outcomes; nevertheless, the cosmetic result is poor and the short- and long-term morbidity is high, and resection of the previous anastomosis and redo is often required. Technique: Surgery is represented by usual laparoscopy using five 5 mm ports; the first step consists of the dissection of the rectovaginal space down to the pelvic floor; afterwards, a modified Vertical Rectus Abdominis pedicled flap (m-VRAM) can be easily harvested full laparoscopically and simply interposed in the rectovaginal space. No additional skin or fascial incisions and no repeat anastomosis were needed. No recurrence, stenosis, or other short- or long-term complications were noted. Conclusion: Our technique is minimally invasive and offers a valid alternative for the treatment of rectovaginal fistulae with low morbidity and no additional incision.
OBJECTIVE:This study investigates the relationship between body mass index (BMI), hernia defect diameter, and early postoperative complications in total extraperitoneal (TEP) hernia repair. METHODS:Of 306 patients undergoing endoscopic inguinal hernia repair between January 2022 and December 2024, 285 patients with completed TEP procedures performed by a single surgeon constituted the final study cohort. Patients were stratified by BMI and hernia defect size. Early postoperative complications within 30 days, including seroma and hematoma, were recorded. Multivariable logistic regression analysis was conducted to identify independent predictors of early complications. All analyses were performed using SPSS version 26.0. RESULTS:Within the 30-day postoperative period, seroma occurred in 36 patients (12.6%) and hematoma in 21 patients (7.4%). Obesity (BMI ≥ 30 kg/m2) was independently associated with increased odds of early postoperative complications (OR 2.8, 95% CI 1.3-5.9, p = 0.02), whereas overweight BMI was not statistically significant (OR 1.2, 95% CI 0.6-2.4, p = 0.34). Hernia defect size ≥ 25 mm was also identified as an independent predictor (OR 2.9, 95% CI 1.4-6.1, p = 0.03). Age > 65 years showed a non-significant trend toward higher complication risk (p = 0.08). CONCLUSION:Obesity and large hernia defects are independent predictors of early complications following TEP hernia repair. Focusing on these factors during preoperative planning may enhance patient safety and outcomes.
BACKGROUND:Inguinal hernia repair is one of the most commonly performed procedures worldwide. Several different methods for repair exist, where the preferred surgical procedure for a non-complicated unilateral inguinal hernia is still up for debate. Originally described as a tissue repair, the introduction of prostheses have led many surgeons to move away from this type of repairs. However, recently updated guidelines still recommend non-mesh treatment, in a subgroup of patients, with a preference for the Shouldice technique. Therefore, we set out to map the incidence and knowledge about tissue-based repair of a primary inguinal hernia in Belgium. METHODS:We designed a voluntary, open web-based survey for both surgeons and trainees asking about their knowledge, experience and indication for tissue-based suture repair, using a Google-forms document. The survey included level of experience and surgical preference, practice of tissue-based inguinal repair, indications for tissue-based repair, and technique and knowledge about tissue-based repair. Data was collected between 1st of December 2023 and 31st of January 2024 and analyzed using Microsoft Excel (version 16.77.01). RESULTS:A total of 122 respondents filled out the questionnaire, 47 trainees and 75 surgeons, of which 4 were discarded due to inaccurate data. Only 15 out of 71 surgical respondents still performed a non-mesh based repair in an elective setting, where the Shouldice repair was the preferred technique (n = 12, 80%). Knowledge about tissue-based mesh was rated mainly moderate (43.7%) and a non-mesh based repair was still considered an option when faced with fecal contamination (54.9%). Upon patient's request, 67.7% respondents would convince patients of mesh superiority. Among surgical trainees eighteen respondents (38.3%) had never seen a tissue based repair before and 36.1% respondents said tissue-based repair was not taught in their current or previous hospital(s). Most surgical trainees (48.9%) had basic knowledge and know a single technique. Considering indications for primary tissue repair, 57.4% mentioned a contaminated field as a valid indication. Comparable to the surgeon's response, 66% of surgical trainees would convince the patient of mesh superiority when asked for a pure tissue-based repair. CONCLUSION:Our survey confirms the declining rate of tissue based repairs, with only 7% of surgical respondents performing sufficient procedures to allow for equivocal result compared to mesh-based repairs. Centralizing these procedures into specific hernia centers might allow for an increased case-load and dedicated training pathways giving trainees and future surgeons proper training.
