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Antonio D'URSO

Hôpitaux Universitaires de Strasbourg
Strasbourg, France
MD, PhD
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Complex cases in laparoscopic recurrent and incisional hernia repair: multi-recurrence, infections, fistulas, difficult abdomen
The term ‘‘complex (abdominal wall) hernia’’ is often used by general surgeons and other specialists working in the abdomen to describe abdominal wall hernias which are technically challenging and time-consuming.

Four categories were created to classify and discuss the criteria, which were proposed to be included in the definition of ‘‘complex abdominal wall hernia’’: defect size and location, patient history and risk factors, contamination and soft tissue condition, and clinical scenario.
Defect size is an important variable; increased size is a risk factor for 30-day readmission rate and recurrence.
Wound contamination is usually classified according to the US National Research Council Group including clean, clean-contaminated, contaminated, and dirty/infected. It is well-known that contamination and subsequent infection are an important cause of wound dehiscence and reherniation which impair wound healing dynamics.
A recurrent hernia is considered a risk factor for a new recurrence.
Patient status is an important factor. Conditions such as abnormal collagen type I/type III ratio and genetic connective tissue disorders are associated with an increased risk of herniation. Older age, male gender, chronic pulmonary disease, coughing, ascites, jaundice, anemia, emergency surgery, wound infection, obesity, steroid use, hypoalbuminemia, hypertension, perioperative shock are also important risk factors.

The reported incidence of incisional hernia is about 2 to 11% after all laparotomies.
The ideal repair for an abdominal incisional hernia is to restore the anatomical and physiological integrity of the abdominal wall by reconstructing the midline. However, 30 to 50% of defects larger than 6cm recur after primary closure.
The insertion of a synthetic mesh helps to decrease or relieve tension on the suture line and can reduce the incidence of recurrence to 10% or less.
But foreign prosthetic materials have been associated with a high risk of complications such as protrusion, extrusion, infection, and intestinal fistulization.
Laparoscopic repair has provided further improvements with lower infection rates, shorter hospital stay, and a reduction in recurrence with rates of 4 to 16% in recent studies.
In this topic addressing complex laparoscopic cases, we show different scenarios including recurrent infected incisional hernia, fistulization, multi-recurrent incisional hernia, migration, and conversion.
Surgical intervention
5 months ago
7371 views
3 likes
0 comments
03:00
Complex cases in laparoscopic recurrent and incisional hernia repair: multi-recurrence, infections, fistulas, difficult abdomen
The term ‘‘complex (abdominal wall) hernia’’ is often used by general surgeons and other specialists working in the abdomen to describe abdominal wall hernias which are technically challenging and time-consuming.

Four categories were created to classify and discuss the criteria, which were proposed to be included in the definition of ‘‘complex abdominal wall hernia’’: defect size and location, patient history and risk factors, contamination and soft tissue condition, and clinical scenario.
Defect size is an important variable; increased size is a risk factor for 30-day readmission rate and recurrence.
Wound contamination is usually classified according to the US National Research Council Group including clean, clean-contaminated, contaminated, and dirty/infected. It is well-known that contamination and subsequent infection are an important cause of wound dehiscence and reherniation which impair wound healing dynamics.
A recurrent hernia is considered a risk factor for a new recurrence.
Patient status is an important factor. Conditions such as abnormal collagen type I/type III ratio and genetic connective tissue disorders are associated with an increased risk of herniation. Older age, male gender, chronic pulmonary disease, coughing, ascites, jaundice, anemia, emergency surgery, wound infection, obesity, steroid use, hypoalbuminemia, hypertension, perioperative shock are also important risk factors.

The reported incidence of incisional hernia is about 2 to 11% after all laparotomies.
The ideal repair for an abdominal incisional hernia is to restore the anatomical and physiological integrity of the abdominal wall by reconstructing the midline. However, 30 to 50% of defects larger than 6cm recur after primary closure.
The insertion of a synthetic mesh helps to decrease or relieve tension on the suture line and can reduce the incidence of recurrence to 10% or less.
But foreign prosthetic materials have been associated with a high risk of complications such as protrusion, extrusion, infection, and intestinal fistulization.
Laparoscopic repair has provided further improvements with lower infection rates, shorter hospital stay, and a reduction in recurrence with rates of 4 to 16% in recent studies.
In this topic addressing complex laparoscopic cases, we show different scenarios including recurrent infected incisional hernia, fistulization, multi-recurrent incisional hernia, migration, and conversion.
Recurrent and incisional hernia repair: complex cases
The term ‘‘complex (abdominal wall) hernia’’ is often used by general surgeons and other specialists working in the abdomen to describe abdominal wall hernias which are technically challenging and time-consuming.

Four categories were created to classify and discuss the criteria, which were proposed to be included in the definition of ‘‘complex abdominal wall hernia’’: defect size and location, patient history and risk factors, contamination and soft tissue condition, and clinical scenario.
Defect size is an important variable; increased size is a risk factor for 30-day readmission rate and recurrence.
Wound contamination is usually classified according to the US National Research Council Group including clean, clean-contaminated, contaminated, and dirty/infected. It is well-known that contamination and subsequent infection are an important cause of wound dehiscence and reherniation which impair wound healing dynamics.
A recurrent hernia is considered a risk factor for a new recurrence.
Patient status is an important factor. Conditions such as abnormal collagen type I/type III ratio and genetic connective tissue disorders are associated with an increased risk of herniation. Older age, male gender, chronic pulmonary disease, coughing, ascites, jaundice, anemia, emergency surgery, wound infection, obesity, steroid use, hypoalbuminemia, hypertension, perioperative shock are also important risk factors.

The reported incidence of incisional hernia is about 2 to 11% after all laparotomies.
The ideal repair for an abdominal incisional hernia is to restore the anatomical and physiological integrity of the abdominal wall by reconstructing the midline. However, 30 to 50% of defects larger than 6cm recur after primary closure.
The insertion of a synthetic mesh helps to decrease or relieve tension on the suture line and can reduce the incidence of recurrence to 10% or less.
But foreign prosthetic materials have been associated with a high risk of complications such as protrusion, extrusion, infection, and intestinal fistulization.
Laparoscopic repair has provided further improvements with lower infection rates, shorter hospital stay, and a reduction in recurrence with rates of 4 to 16% in recent studies.
In this topic addressing complex laparoscopic cases, we show different scenarios including recurrent infected incisional hernia, fistulization, multi-recurrent incisional hernia, migration, and conversion.
State of the art
5 months ago
1807 views
9 likes
0 comments
00:00
Recurrent and incisional hernia repair: complex cases
The term ‘‘complex (abdominal wall) hernia’’ is often used by general surgeons and other specialists working in the abdomen to describe abdominal wall hernias which are technically challenging and time-consuming.

Four categories were created to classify and discuss the criteria, which were proposed to be included in the definition of ‘‘complex abdominal wall hernia’’: defect size and location, patient history and risk factors, contamination and soft tissue condition, and clinical scenario.
Defect size is an important variable; increased size is a risk factor for 30-day readmission rate and recurrence.
Wound contamination is usually classified according to the US National Research Council Group including clean, clean-contaminated, contaminated, and dirty/infected. It is well-known that contamination and subsequent infection are an important cause of wound dehiscence and reherniation which impair wound healing dynamics.
A recurrent hernia is considered a risk factor for a new recurrence.
Patient status is an important factor. Conditions such as abnormal collagen type I/type III ratio and genetic connective tissue disorders are associated with an increased risk of herniation. Older age, male gender, chronic pulmonary disease, coughing, ascites, jaundice, anemia, emergency surgery, wound infection, obesity, steroid use, hypoalbuminemia, hypertension, perioperative shock are also important risk factors.

The reported incidence of incisional hernia is about 2 to 11% after all laparotomies.
The ideal repair for an abdominal incisional hernia is to restore the anatomical and physiological integrity of the abdominal wall by reconstructing the midline. However, 30 to 50% of defects larger than 6cm recur after primary closure.
The insertion of a synthetic mesh helps to decrease or relieve tension on the suture line and can reduce the incidence of recurrence to 10% or less.
But foreign prosthetic materials have been associated with a high risk of complications such as protrusion, extrusion, infection, and intestinal fistulization.
Laparoscopic repair has provided further improvements with lower infection rates, shorter hospital stay, and a reduction in recurrence with rates of 4 to 16% in recent studies.
In this topic addressing complex laparoscopic cases, we show different scenarios including recurrent infected incisional hernia, fistulization, multi-recurrent incisional hernia, migration, and conversion.
Laparoscopic Spigelian hernia repair
Spigelian hernia is a rare condition and it is difficult to diagnose it clinically. It has been estimated to account for 0.12% of abdominal wall hernias. The hernia ring is a well-defined defect in the transversus abdominis aponeurosis. The hernia sac, surrounded with extraperitoneal adipose tissue, often lies interparietally passing through the transversus abdominis and the internal oblique muscle aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique muscle. The laparoscopic repair is well-established. Most authors use a transperitoneal approach either by placing the mesh in an intraperitoneal position or by raising the peritoneal flap and placing the mesh in the extraperitoneal space. In this video, we demonstrate the laparoscopic repair of a Spigelian hernia through the transabdominal preperitoneal (TAPP) placement of a composite mesh.
Surgical intervention
8 months ago
2710 views
12 likes
2 comments
08:23
Laparoscopic Spigelian hernia repair
Spigelian hernia is a rare condition and it is difficult to diagnose it clinically. It has been estimated to account for 0.12% of abdominal wall hernias. The hernia ring is a well-defined defect in the transversus abdominis aponeurosis. The hernia sac, surrounded with extraperitoneal adipose tissue, often lies interparietally passing through the transversus abdominis and the internal oblique muscle aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique muscle. The laparoscopic repair is well-established. Most authors use a transperitoneal approach either by placing the mesh in an intraperitoneal position or by raising the peritoneal flap and placing the mesh in the extraperitoneal space. In this video, we demonstrate the laparoscopic repair of a Spigelian hernia through the transabdominal preperitoneal (TAPP) placement of a composite mesh.
ERCP in a patient with previous subtotal gastrectomy for cancer: hybrid approach with transjejunal access
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with prior gastric surgery (Roux-en-Y gastric bypass, partial or subtotal gastrectomy) is a challenging procedure. Despite technological advances in endoscopy, reaching the duodenum and entering the bile duct remains difficult. Laparoscopic assisted ERCP (LAERCP) allows the duodenum to be accessed through the excluded stomach in case of previous RYGB or through the proximal jejunum in case of gastric resection. The objective of this video is to demonstrate the hybrid approach in a patient with a previous subtotal gastrectomy for gastric cancer.
Surgical intervention
8 months ago
143 views
2 likes
0 comments
12:02
ERCP in a patient with previous subtotal gastrectomy for cancer: hybrid approach with transjejunal access
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with prior gastric surgery (Roux-en-Y gastric bypass, partial or subtotal gastrectomy) is a challenging procedure. Despite technological advances in endoscopy, reaching the duodenum and entering the bile duct remains difficult. Laparoscopic assisted ERCP (LAERCP) allows the duodenum to be accessed through the excluded stomach in case of previous RYGB or through the proximal jejunum in case of gastric resection. The objective of this video is to demonstrate the hybrid approach in a patient with a previous subtotal gastrectomy for gastric cancer.
Laparoscopic appendectomy for recurrent appendicitis after medical treatment
Appendectomy is the only curative treatment of appendicitis. However, the management of patients with an appendiceal mass or abscess can be temporarily managed medically with intravenous antibiotic therapy and/or percutaneous drainage. And yet, there are many controversies over the non-operative management of acute appendicitis. In 2015, Fair et al. used data from the American College of Surgeons National Surgical Quality Improvement Project to evaluate 30-day morbidity and mortality of intervention (laparoscopic and open appendectomy) at different time periods. A delay of operative intervention longer than 48 hours was associated with a doubling of complication rates. Elective appendectomy can be performed after 6 to 8 weeks later, which proves successful in the vast majority of patients.
This is the case of an 83-year-old man who presented with an acute appendicitis treated medically in another hospital. The patient had a past medical history of arterial hypertension, cardiomyopathy, previous cerebral ischemia, and rectal polyp. A delayed appendectomy was planned. However, before the procedure, a total colonoscopy was performed because of the history of polyps. This elderly patient was hospitalized for colonoscopy. At admission, he presented with fever, right iliac fossa tenderness, and a biological inflammatory syndrome. A CT-scan was performed. It showed a recurrent acute appendicitis without mass, with a 2cm abscess on the tip of the appendix. An appendectomy was performed in this case.
Surgical intervention
1 year ago
4610 views
341 likes
0 comments
05:00
Laparoscopic appendectomy for recurrent appendicitis after medical treatment
Appendectomy is the only curative treatment of appendicitis. However, the management of patients with an appendiceal mass or abscess can be temporarily managed medically with intravenous antibiotic therapy and/or percutaneous drainage. And yet, there are many controversies over the non-operative management of acute appendicitis. In 2015, Fair et al. used data from the American College of Surgeons National Surgical Quality Improvement Project to evaluate 30-day morbidity and mortality of intervention (laparoscopic and open appendectomy) at different time periods. A delay of operative intervention longer than 48 hours was associated with a doubling of complication rates. Elective appendectomy can be performed after 6 to 8 weeks later, which proves successful in the vast majority of patients.
This is the case of an 83-year-old man who presented with an acute appendicitis treated medically in another hospital. The patient had a past medical history of arterial hypertension, cardiomyopathy, previous cerebral ischemia, and rectal polyp. A delayed appendectomy was planned. However, before the procedure, a total colonoscopy was performed because of the history of polyps. This elderly patient was hospitalized for colonoscopy. At admission, he presented with fever, right iliac fossa tenderness, and a biological inflammatory syndrome. A CT-scan was performed. It showed a recurrent acute appendicitis without mass, with a 2cm abscess on the tip of the appendix. An appendectomy was performed in this case.
Laparoscopic postpartum right diaphragmatic hernia reduction
A 35-year-old patient was referred to our emergency department for acute abdominal pain and respiratory distress. The patient gave natural childbirth three days before the episode, a childbirth without immediate complications.
Clinically, the patient presented with tachypnea, tachycardia, and desaturation, nauseas and constipation, depressible abdomen with generalized pain on palpation. The absence of vesicular murmur and right lung dullness were noted.
Blood lab findings showed increased inflammatory parameters.
An abdominothoracic CT-scan with contrast was performed. It showed a voluminous right diaphragmatic hernia containing the omentum, a distended colon and liver segment VIII with signs of hypoperfusion.
A surgical procedure was performed. A laparoscopic approach was performed and the patient’s hiatal hernia was reduced by closing the defect with a non-absorbable suture and by placing a Vicryl mesh.
The patient recovered with no complications and was discharged on postoperative day 3.
Surgical intervention
2 years ago
1823 views
112 likes
0 comments
09:10
Laparoscopic postpartum right diaphragmatic hernia reduction
A 35-year-old patient was referred to our emergency department for acute abdominal pain and respiratory distress. The patient gave natural childbirth three days before the episode, a childbirth without immediate complications.
Clinically, the patient presented with tachypnea, tachycardia, and desaturation, nauseas and constipation, depressible abdomen with generalized pain on palpation. The absence of vesicular murmur and right lung dullness were noted.
Blood lab findings showed increased inflammatory parameters.
An abdominothoracic CT-scan with contrast was performed. It showed a voluminous right diaphragmatic hernia containing the omentum, a distended colon and liver segment VIII with signs of hypoperfusion.
A surgical procedure was performed. A laparoscopic approach was performed and the patient’s hiatal hernia was reduced by closing the defect with a non-absorbable suture and by placing a Vicryl mesh.
The patient recovered with no complications and was discharged on postoperative day 3.
Live interactive transanal TME (TaTME) with the TEO™ platform
Randomized clinical trials such as COLOR II, COREAN and CLASICC, have shown better results for laparoscopic total mesorectal excision (TME), in terms of short-term and long-term outcomes, when compared with open TME.
Laparoscopic TME presents some limitations such as low rectal cancer which has a high risk of leaving a positive circumferential resection margin (CRM) and a narrow pelvis. Conversion to open procedures remains unsatisfactory.
Transanal TME (taTME) has been proposed to give a new option in cases where laparoscopic TME is difficult.
In this video, we present the case of a transanal approach with the TEO™ platform for low rectal cancer.
Surgical intervention
2 years ago
3854 views
324 likes
0 comments
45:51
Live interactive transanal TME (TaTME) with the TEO™ platform
Randomized clinical trials such as COLOR II, COREAN and CLASICC, have shown better results for laparoscopic total mesorectal excision (TME), in terms of short-term and long-term outcomes, when compared with open TME.
Laparoscopic TME presents some limitations such as low rectal cancer which has a high risk of leaving a positive circumferential resection margin (CRM) and a narrow pelvis. Conversion to open procedures remains unsatisfactory.
Transanal TME (taTME) has been proposed to give a new option in cases where laparoscopic TME is difficult.
In this video, we present the case of a transanal approach with the TEO™ platform for low rectal cancer.
Laparoscopic appendectomy after appendicular phlegmon
Appendicitis is one of the main reasons for consultation and surgical interventions in the emergency departments around the world. If it is not diagnosed and treated timely, it can evolve towards an appendicular perforation, and as a result, it can become a peritonitis or an appendicular phlegmon. This latter case may occur in approximately 10% of cases.
Currently, the management of the appendicular phlegmon is controversial. Some authors prefer to perform an appendectomy immediately, and others are in favor of medical treatment using antibiotic therapy and percutaneous drainage if possible and delay appendectomy.
In this case, we present a patient presenting with an appendicular phlegmon in which a conservative management with percutaneous drainage and delayed surgery were decided upon.
Surgical intervention
2 years ago
8873 views
520 likes
0 comments
04:17
Laparoscopic appendectomy after appendicular phlegmon
Appendicitis is one of the main reasons for consultation and surgical interventions in the emergency departments around the world. If it is not diagnosed and treated timely, it can evolve towards an appendicular perforation, and as a result, it can become a peritonitis or an appendicular phlegmon. This latter case may occur in approximately 10% of cases.
Currently, the management of the appendicular phlegmon is controversial. Some authors prefer to perform an appendectomy immediately, and others are in favor of medical treatment using antibiotic therapy and percutaneous drainage if possible and delay appendectomy.
In this case, we present a patient presenting with an appendicular phlegmon in which a conservative management with percutaneous drainage and delayed surgery were decided upon.
The VERSA LIFTER BAND™: a new option for liver retraction in laparoscopic Roux-en-Y gastric bypass for morbid obesity
During laparoscopic bariatric procedures in morbidly obese patients, the surgeon's operative view is often obscured by the hypertrophic adipose left lobe of the liver.
To provide adequate operative views and working space, an appropriate retraction of the left liver lobe is required.
The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in patient discomfort for pain and scar formation, with the additional risk of iatrogenic liver injury during retraction maneuvers.
To overcome these limitations, we present the use of a simple, rapid, and safe technique for liver retraction using the VERSA LIFTER™ Band disposable liver suspension system or retractor.
Surgical intervention
3 years ago
1719 views
38 likes
0 comments
03:48
The VERSA LIFTER BAND™: a new option for liver retraction in laparoscopic Roux-en-Y gastric bypass for morbid obesity
During laparoscopic bariatric procedures in morbidly obese patients, the surgeon's operative view is often obscured by the hypertrophic adipose left lobe of the liver.
To provide adequate operative views and working space, an appropriate retraction of the left liver lobe is required.
The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in patient discomfort for pain and scar formation, with the additional risk of iatrogenic liver injury during retraction maneuvers.
To overcome these limitations, we present the use of a simple, rapid, and safe technique for liver retraction using the VERSA LIFTER™ Band disposable liver suspension system or retractor.
Robot-assisted gastric band removal
Adjustable gastric banding (AGB) is one of the surgical treatment modalities for morbid obesity. Over the years, popularity for this treatment increased. It has been by far the most performed bariatric procedure for years in Europe and in the United States. Many gastric band removals are linked to complications and weight loss failure, indicating a new bariatric procedure for some of the patients. Complications after AGB are not uncommon and consist mainly of gastroesophageal reflux disease, pouch dilatation, slippage of the band, and intragastric migration. The failure of the gastric band is multifactorial. Gastric band removal does not preclude a new bariatric procedure (the most common procedure performed in our department is Roux en-Y gastric bypass), which is feasible in the same operative time but the 2-step approach is suitable. The new bariatric procedure offers adequate surgical outcomes and satisfactory results in terms of weight loss.
Surgical intervention
4 years ago
1102 views
36 likes
0 comments
08:14
Robot-assisted gastric band removal
Adjustable gastric banding (AGB) is one of the surgical treatment modalities for morbid obesity. Over the years, popularity for this treatment increased. It has been by far the most performed bariatric procedure for years in Europe and in the United States. Many gastric band removals are linked to complications and weight loss failure, indicating a new bariatric procedure for some of the patients. Complications after AGB are not uncommon and consist mainly of gastroesophageal reflux disease, pouch dilatation, slippage of the band, and intragastric migration. The failure of the gastric band is multifactorial. Gastric band removal does not preclude a new bariatric procedure (the most common procedure performed in our department is Roux en-Y gastric bypass), which is feasible in the same operative time but the 2-step approach is suitable. The new bariatric procedure offers adequate surgical outcomes and satisfactory results in terms of weight loss.
Stomal prolapse and parastomal incisional hernia treatment using laparoscopic Sugarbaker modified technique with intraperitoneal onlay mesh repair
Introduction: Prolapse stands for one of the most common complications of colostomy (>10%). Parastomal incisional hernia also represents 10 to 50% of complications. When both are present, the Sugarbaker technique represents a good indication due to mesh repair and pseudo-subperitonization, which can manage both prolapse and hernia. The laparoscopic modified Sugarbaker technique can be performed laparoscopically even in case of multiple previous laparotomies.
Clinical case: We report the case of a 71-year-old male patient presenting with parastomal incisional hernia and stomal prolapse after multiple abdominal procedures for ulcerative colitis, including rectosigmoidectomy, Hartmann procedure for anastomotic leak, left extended colectomy and stomal transposition for ischemic necrosis. An intra-abdominal proctectomy was attempted to manage the recurrence of colitis on the rectal stump. However, this attempt proved unsuccessful, and a local abdominoperineal resection was performed. Due to symptomatic hernia and prolapse, the laparoscopic Sugarbaker modified surgical technique with intraperitoneal onlay mesh (IPOM) repair is performed to manage prolapse by pseudo-subperitonization and to manage hernia using an IPOM repair. As shown in this video, this technique is safe, reproducible, and effective.
Surgical intervention
4 years ago
2383 views
99 likes
0 comments
10:54
Stomal prolapse and parastomal incisional hernia treatment using laparoscopic Sugarbaker modified technique with intraperitoneal onlay mesh repair
Introduction: Prolapse stands for one of the most common complications of colostomy (>10%). Parastomal incisional hernia also represents 10 to 50% of complications. When both are present, the Sugarbaker technique represents a good indication due to mesh repair and pseudo-subperitonization, which can manage both prolapse and hernia. The laparoscopic modified Sugarbaker technique can be performed laparoscopically even in case of multiple previous laparotomies.
Clinical case: We report the case of a 71-year-old male patient presenting with parastomal incisional hernia and stomal prolapse after multiple abdominal procedures for ulcerative colitis, including rectosigmoidectomy, Hartmann procedure for anastomotic leak, left extended colectomy and stomal transposition for ischemic necrosis. An intra-abdominal proctectomy was attempted to manage the recurrence of colitis on the rectal stump. However, this attempt proved unsuccessful, and a local abdominoperineal resection was performed. Due to symptomatic hernia and prolapse, the laparoscopic Sugarbaker modified surgical technique with intraperitoneal onlay mesh (IPOM) repair is performed to manage prolapse by pseudo-subperitonization and to manage hernia using an IPOM repair. As shown in this video, this technique is safe, reproducible, and effective.
Chronic sigmoidovesical fistula: laparoscopic management
The most frequent underlying cause of sigmoidovesical fistula is complicated diverticular disease in 60% of cases followed by colorectal cancer and inflammatory bowel disease. It occurs in about 2 to 22% of patients with known diverticular disease. In diverticular sigmoid vesical chronic fistula, the preferred therapeutic management is represented by primary resection with anastomosis performed as a one-stage procedure. It is particularly true when the fistula is located between the vesical dome and the sigmoid colon distally from the trigone vesical. In this video, we demonstrate the laparoscopic management of a chronic sigmoidovesical fistula after acute sigmoid diverticulitis as a one-stage procedure.
Surgical intervention
4 years ago
2051 views
61 likes
0 comments
07:01
Chronic sigmoidovesical fistula: laparoscopic management
The most frequent underlying cause of sigmoidovesical fistula is complicated diverticular disease in 60% of cases followed by colorectal cancer and inflammatory bowel disease. It occurs in about 2 to 22% of patients with known diverticular disease. In diverticular sigmoid vesical chronic fistula, the preferred therapeutic management is represented by primary resection with anastomosis performed as a one-stage procedure. It is particularly true when the fistula is located between the vesical dome and the sigmoid colon distally from the trigone vesical. In this video, we demonstrate the laparoscopic management of a chronic sigmoidovesical fistula after acute sigmoid diverticulitis as a one-stage procedure.
Endoscope-guided Nissen fundoplication
Gastroesophageal reflux (GERD) is a common and almost endemic problem in the Western world. Laparoscopic anti-reflux surgery is an effective and durable treatment for GERD in patients who are well-selected. Selection depends on a careful assessment of symptoms and a thorough physiologic evaluation with endoscopy, pH-monitoring and esophageal manometry. In more advanced and difficult cases, additional tests may be indicated. Cases encountered in practice range from straight forward and "everyday" to extremely complex and difficult; both in the decision-making, the operation, and the patient management. The common thread between all cases of anti-reflux surgery, complex or simple, is a stepwise and organized approach that takes into consideration the individual patient's disease and physiology. We present a case in this video that is not complex but which provides a good illustration of the technical steps required to recreate an effective gastroesophageal valve. We emphasize an atraumatic and efficient approach to the operation that ensures optimal outcomes and will minimize intraoperative complications. We discuss the characteristics of a properly formed fundoplication and debate with other experts some of the minor technical details such as suture patterns and materials. We also show how intraoperative endoscopy can serve as a powerful tool for quality control and postulate that surgeons can improve their results if they adopt routine interoperative control by endoscopy. We hope that you will enjoy and benefit from this case…
Surgical intervention
4 years ago
2553 views
124 likes
0 comments
36:15
Endoscope-guided Nissen fundoplication
Gastroesophageal reflux (GERD) is a common and almost endemic problem in the Western world. Laparoscopic anti-reflux surgery is an effective and durable treatment for GERD in patients who are well-selected. Selection depends on a careful assessment of symptoms and a thorough physiologic evaluation with endoscopy, pH-monitoring and esophageal manometry. In more advanced and difficult cases, additional tests may be indicated. Cases encountered in practice range from straight forward and "everyday" to extremely complex and difficult; both in the decision-making, the operation, and the patient management. The common thread between all cases of anti-reflux surgery, complex or simple, is a stepwise and organized approach that takes into consideration the individual patient's disease and physiology. We present a case in this video that is not complex but which provides a good illustration of the technical steps required to recreate an effective gastroesophageal valve. We emphasize an atraumatic and efficient approach to the operation that ensures optimal outcomes and will minimize intraoperative complications. We discuss the characteristics of a properly formed fundoplication and debate with other experts some of the minor technical details such as suture patterns and materials. We also show how intraoperative endoscopy can serve as a powerful tool for quality control and postulate that surgeons can improve their results if they adopt routine interoperative control by endoscopy. We hope that you will enjoy and benefit from this case…
Onset of internal hernia after Roux-en-Y gastric bypass: laparoscopic management
Laparoscopic Roux-en-Y gastric bypass (LRYGB) represents the gold standard of treatment for morbidly obese patients. While the laparoscopic approach offers many advantages in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, certain complications of this operation present difficult clinical problems. The most challenging complication to determine is internal hernia through one of the mesenteric defects.

Internal hernias occur more frequently in LRYGB than in the open procedure. This is a significant clinical problem since internal hernia is the most common cause of small bowel obstruction (SBO) after LRYGB, which can result in ischemia or infarction and often requires a reoperation.

The incidence of SBO after LGBP is reported to be between 1.8 and 9.7%. The most common site of internal hernia after LGBP is at Petersen’s space.
In this video, we present the laparoscopic management of a complete small bowel herniation at Petersen’s space.
Surgical intervention
5 years ago
1306 views
17 likes
0 comments
11:25
Onset of internal hernia after Roux-en-Y gastric bypass: laparoscopic management
Laparoscopic Roux-en-Y gastric bypass (LRYGB) represents the gold standard of treatment for morbidly obese patients. While the laparoscopic approach offers many advantages in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, certain complications of this operation present difficult clinical problems. The most challenging complication to determine is internal hernia through one of the mesenteric defects.

Internal hernias occur more frequently in LRYGB than in the open procedure. This is a significant clinical problem since internal hernia is the most common cause of small bowel obstruction (SBO) after LRYGB, which can result in ischemia or infarction and often requires a reoperation.

The incidence of SBO after LGBP is reported to be between 1.8 and 9.7%. The most common site of internal hernia after LGBP is at Petersen’s space.
In this video, we present the laparoscopic management of a complete small bowel herniation at Petersen’s space.
Laparoscopic management of right hydrothorax following peritoneal dialysis (PD)
Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of peritoneal dialysis (PD) but generally does not threaten life. The most current surgical option is the thoracoscopic approach. In this video, we propose an alternative treatment through an abdominal laparoscopic approach.
Hydrothorax occurs rarely but represents a well-recognized complication of peritoneal dialysis (PD). The incidence of this condition ranges between 1.6% and 10% of peritoneal dialysis patients. Patients typically present with respiratory symptoms associated with reduction of dialysis fluid. The presence of pleuroperitoneal communication has been identified as the most common reason explaining hydrothorax in peritoneal dialysis.
Conservative medical treatment is not effective. Surgical approaches range from open repair through a thoracotomy to video-assisted thoracoscopy surgery (VATS) with or without chemical or mechanical pleurodesis.
Surgical intervention
5 years ago
707 views
11 likes
0 comments
04:02
Laparoscopic management of right hydrothorax following peritoneal dialysis (PD)
Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of peritoneal dialysis (PD) but generally does not threaten life. The most current surgical option is the thoracoscopic approach. In this video, we propose an alternative treatment through an abdominal laparoscopic approach.
Hydrothorax occurs rarely but represents a well-recognized complication of peritoneal dialysis (PD). The incidence of this condition ranges between 1.6% and 10% of peritoneal dialysis patients. Patients typically present with respiratory symptoms associated with reduction of dialysis fluid. The presence of pleuroperitoneal communication has been identified as the most common reason explaining hydrothorax in peritoneal dialysis.
Conservative medical treatment is not effective. Surgical approaches range from open repair through a thoracotomy to video-assisted thoracoscopy surgery (VATS) with or without chemical or mechanical pleurodesis.
Robot-assisted gastric band removal: any limitations?
Nowadays, indications for gastric band removal are well-standardized. In case of esophageal or gastric dilatation, migration or any injury related to the LAP-BAND® access port or tubing, the band and its access port should be removed. In rare specific cases, part of the LAP-BAND® system (either access port or band) may be preserved.
Before proceeding to the surgical band removal, a complete preoperative radiological and endoscopic work-up should be performed.
Here, we present the case of a 62-year-old woman who benefited from gastric band placement 10 years earlier. The band proved effective. However, for several weeks, she has been suffering from abdominal pain associated with vomiting and hematemesis.
After a work-up which included CT-scanning, water-soluble contrast swallow and gastroscopy, it was decided to remove the band.
Surgical intervention
5 years ago
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Robot-assisted gastric band removal: any limitations?
Nowadays, indications for gastric band removal are well-standardized. In case of esophageal or gastric dilatation, migration or any injury related to the LAP-BAND® access port or tubing, the band and its access port should be removed. In rare specific cases, part of the LAP-BAND® system (either access port or band) may be preserved.
Before proceeding to the surgical band removal, a complete preoperative radiological and endoscopic work-up should be performed.
Here, we present the case of a 62-year-old woman who benefited from gastric band placement 10 years earlier. The band proved effective. However, for several weeks, she has been suffering from abdominal pain associated with vomiting and hematemesis.
After a work-up which included CT-scanning, water-soluble contrast swallow and gastroscopy, it was decided to remove the band.