Thomas J. VanderMeer

Intraductal Papillary Mucinous Neoplasm: A Clinicopathologic Review

Intraductal papillary mucinous neoplasm (IPMN) is an intraductal mucin-producing epithelial neoplasm that arises from the main pancreatic duct (MD-IPMN), secondary branch ducts (BD-IPMN), or both (mixed type; Mix-IPMN). Neoplastic progression from benign adenoma to invasive adenocarcinoma has not been proven but is generally thought to occur. With increasing recognition of IPMN, our understanding of the diagnosis and management of the tumors is evolving. At present, treatment options for patients with IPMN range from observation to pancreatic resection depending on the natural history of the lesion. This review focuses on currently available data that guide management decisions for patients with IPMN.

Ventral hernia repair: outcomes change with long-term follow-up.

Most ventral hernia recurrences happen within 2 years of surgery. There appears to be a continued although low subsequent yearly rate of recurrence for open repairs.

T1600 Ventral Hernias: A Six Year Outcome Analysis from a Rural Teaching Hospital

Background: In the paucity of large studies comparing treatment outcomes for ventral hernias, surgical technique still largely remains a matter of personal preference and expertise. We carried out a large analytical study of current practice in the setting of a large community hospital with the aim to assess treatment strategies and determine factors influencing outcomes. Method: Electronic medical records of all patients who had a ventral hernia repair from January 2001 to October 2006 at our hospital were retrospectively analyzed. The time of follow-up ranged from 7.5 years to 18 months (median of 4.5 years). Results: A total of 223 ventral hernia repairs were performed during the study period of which 73 (32.7%) were done laparoscopically and 150 (67.3%) were open procedures. Of the 223 procedures, 144 (64.6%) were primary hernias and 79 (35.4%) were recurrent hernias. Significantly more, 32 of 79 (40.5%) patients with a recurrent hernia were found to have a Swiss-cheese defect as opposed to only 33 of 144 (22.9%) who had a primary hernia (chi-squared p= 0.006). A recurrence occurred in 54 of 223 (24.2%) patients. Co-morbid conditions and hernia size did not have a significant association with hernia recurrence. Significantly, a recurrence occurred in only 10 of 73 (13.6%) patients who had a laparoscopic repair compared to 44 of 150 (29.3%) patients who had an open repair (chi-square p= 0.011). A recurrent hernia was noted in 22 of 68 (32.3%) patients in whom repair was carried out without use of a mesh, as compared to 32 of 152 (21.1%) patients in whom a mesh repair was done, however this was not statistically significant (p= 0.072). Post-operative short term complications occurred in 31.4% of patients including recurrences in 11.7%, wound infections in 5.4%, and symptomatic seromas in 4.5% patients. Conclusion: A significantly higher percentage of patients who had a recurrent hernia repair were noted to have a Swiss cheese defect. This finding suggests either an inherent weakness of the abdominal wall predisposing to recurrence or that a defect in the fascia was missed during previous repair. Our recurrence rate was significantly lower after laparoscopic repair as compared to an open repair. This again supports the hypothesis that laparoscopic repair improves visualization and enables wider coverage of the anterior abdominal wall with mesh and hence may result in repair or prevention of additional defects in the abdominal wall musculature. We conclude that even in the setting of a community hospital there seems to be more justification for carrying out laparoscopic repair of ventral hernias in order to reduce recurrence rates.