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Ettore MARZANO

Hôpitaux Universitaires de Strasbourg
Strasbourg, France
MD
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Laparoscopic right hemihepatectomy for polyadenomatosis
Hepatic adenomatosis was first described in 1985 by Flejou et al. as multiple adenomas (arbitrarily more than 10), in an otherwise normal liver parenchyma. Several authors have suggested that it is a distinct entity from hepatic adenoma, which is predominantly seen in young women taking oral contraceptives. Although considered a benign disease, it can be associated with potentially fatal complications such as malignant transformation and intraperitoneal hemorrhage due to rupture. Currently, there is no consensus on patient management. However, surgical removal of large lesions may significantly improve symptoms and reduce the risk of complications. Genetic counselling may now play an important role in case management.
We report the case of a 33-year-old woman who underwent a laparoscopic right liver resection for multiple liver adenomatosis. This patient had already had a right liver-appended adenoma resected as well as a cholecystectomy. Five trocars are placed in a semilunar fashion approximately one handbreadth apart along a line one handbreadth below the right subcostal margin. Hepatic inflow is taken extraparenchymally before the transection of the hepatic parenchyma in an anterior to posterior fashion.
Surgical intervention
7 years ago
2729 views
15 likes
0 comments
20:21
Laparoscopic right hemihepatectomy for polyadenomatosis
Hepatic adenomatosis was first described in 1985 by Flejou et al. as multiple adenomas (arbitrarily more than 10), in an otherwise normal liver parenchyma. Several authors have suggested that it is a distinct entity from hepatic adenoma, which is predominantly seen in young women taking oral contraceptives. Although considered a benign disease, it can be associated with potentially fatal complications such as malignant transformation and intraperitoneal hemorrhage due to rupture. Currently, there is no consensus on patient management. However, surgical removal of large lesions may significantly improve symptoms and reduce the risk of complications. Genetic counselling may now play an important role in case management.
We report the case of a 33-year-old woman who underwent a laparoscopic right liver resection for multiple liver adenomatosis. This patient had already had a right liver-appended adenoma resected as well as a cholecystectomy. Five trocars are placed in a semilunar fashion approximately one handbreadth apart along a line one handbreadth below the right subcostal margin. Hepatic inflow is taken extraparenchymally before the transection of the hepatic parenchyma in an anterior to posterior fashion.
Laparoscopic repair of giant type 4 paraesophageal hernia
Type 4 giant hiatal hernias are not common. The stomach is herniated, as well as viscera in the mediastinum, colon, spleen, and even sometimes in the pancreas. Repair is challenging for different reasons. This type of hernia is frequent in older and fragile patients. Reduction of the sac from the mediastinum is mandatory and must be carried out following stepwise and precise dissection rules: it has to be done outside of the sac, in an anatomical cleavage plane. Crural repair is challenging and must be tailored on the quality of the diaphragmatic musculature and size of the orifice. Anti-reflux repair must be performed as well. The laparoscopic approach has radically improved the clinical outcome of this procedure in old patients.
Surgical intervention
7 years ago
4797 views
82 likes
0 comments
21:43
Laparoscopic repair of giant type 4 paraesophageal hernia
Type 4 giant hiatal hernias are not common. The stomach is herniated, as well as viscera in the mediastinum, colon, spleen, and even sometimes in the pancreas. Repair is challenging for different reasons. This type of hernia is frequent in older and fragile patients. Reduction of the sac from the mediastinum is mandatory and must be carried out following stepwise and precise dissection rules: it has to be done outside of the sac, in an anatomical cleavage plane. Crural repair is challenging and must be tailored on the quality of the diaphragmatic musculature and size of the orifice. Anti-reflux repair must be performed as well. The laparoscopic approach has radically improved the clinical outcome of this procedure in old patients.