CASE PRESENTATION: We present here a novel technique of using intravenous (IV) cannula as an alternative to suture passer for fascial closure during laparoscopic IPOM repair for a 59-year-old patient with an incisional ventral hernia. The placement of non-absorbable sutures for fascial closure was done with the help of a 14 gauge IV cannula instead of a transfascial suture passer. The rest of the procedural steps were the same as a standard laparoscopic IPOM repair. The patient's post-operative recovery was uneventful.
DISCUSSION: Primary fascial closure during a laparoscopic IPOM hernia repair can be done either by intracorporeal or extracorporeal techniques, using interrupted or continuous sutures. We propose a novel alternative to suture passer in primary fascial closure. IV cannulas are widely available in hospital settings. The advantage of using an IV cannula instead of a suture passer is that they are widely available. Its single-use also eliminates the risk of transmissible diseases, and as it has a smaller diameter than suture passer, it requires a lower insertion force for successful placement.
CONCLUSION: An IV cannula may be used as a more economical alternative to a transfascial suture passer. This technique is easily reproducible and does not violate the principles of primary fascial defect closure in laparoscopic ventral hernia repair.
CASE PRESENTATION: We present a case of a 61-year-old lady with mitral valve prolapse (MVP) who underwent TOE with subsequent presentation of odynophagia with left neck swelling. An upper endoscopy examination was inconclusive; however, a contrasted computed tomography of the neck showed evidence of cervical oesophageal perforation. She was managed conservatively and discharged well.
DISCUSSION: The trauma caused by TOE probe insertion and manipulation accounts for most of the upper gastrointestinal complications. Mortality of patients associated with oesophageal perforation can be up to 20% and doubled if the treatment is delayed for more than 24 h. Mechanism of injury from TOE probe is likely multifactorial. Predisposing factors that increase the risk of tissue disruption include the presence of unknown structural pathology. Imaging studies and an upper endoscopy examination may aid in the diagnosis of oesophageal perforation.
CONCLUSION: A high index of suspicion, coupled with a tailored, multidisciplinary approach, is essential to achieve the best possible outcome. Conservative management may be worthwhile in a stable patient despite delayed presentation. Although TOE is considered a safe procedure, physicians should be made aware of such a dreaded complication.