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Colonic perforation: laparoscopic approach
An 89-year-old man was admitted to hospital because of complaints of abdominal pain and diarrhea with a one-month evolution. His medical history included atrial fibrillation for which he was on anticoagulants, type 2 diabetes mellitus, and recurrent syncopes. The patient’s surgical history included cholecystectomy, right inguinal hernioplasty, and prostatectomy. During the performance of a colonoscopy, the patient had an onset of intense and widespread abdominal pain. Colonoscopy showed a suspicion of perforation at the level of the sigmoid colon, without any evidence of tumor-like lesions. CT-scan showed a pneumoperitoneum and perforation at the level of the distal sigmoid colon. It was decided to perform a laparoscopic approach. A perforation was identified in the rectosigmoid junction. The perforation was sutured.
The patient presented with an acute coronary syndrome in the immediate postoperative period, which was managed with medical treatment. Subsequently, the patient had symptoms of paralytic ileus, which were managed conservatively with subsequent recovery of bowel transit. The patient was discharged on postoperative day 10.
I Fraile Alonso, A Trinidad Borras, J Álvarez Martin
Surgical intervention
2 months ago
1473 views
18 likes
9 comments
07:42
Colonic perforation: laparoscopic approach
An 89-year-old man was admitted to hospital because of complaints of abdominal pain and diarrhea with a one-month evolution. His medical history included atrial fibrillation for which he was on anticoagulants, type 2 diabetes mellitus, and recurrent syncopes. The patient’s surgical history included cholecystectomy, right inguinal hernioplasty, and prostatectomy. During the performance of a colonoscopy, the patient had an onset of intense and widespread abdominal pain. Colonoscopy showed a suspicion of perforation at the level of the sigmoid colon, without any evidence of tumor-like lesions. CT-scan showed a pneumoperitoneum and perforation at the level of the distal sigmoid colon. It was decided to perform a laparoscopic approach. A perforation was identified in the rectosigmoid junction. The perforation was sutured.
The patient presented with an acute coronary syndrome in the immediate postoperative period, which was managed with medical treatment. Subsequently, the patient had symptoms of paralytic ileus, which were managed conservatively with subsequent recovery of bowel transit. The patient was discharged on postoperative day 10.
Laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Morbid obesity has reached epidemic proportions. Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective bariatric surgery procedure for weight loss. This procedure was first described by Scopinaro in 1979. It consisted of a horizontal gastrectomy, a transection of the bowel halfway from the ligament of Treitz and the ileocecal junction, and a Roux-en-Y reconstruction with a 50cm common channel. This was later modified: the duodenal switch was added and the gastrectomy was performed in a vertical sleeve fashion, thereby preserving the pylorus and increasing the common channel to 100cm. This modification greatly reduced the incidence of marginal ulceration, dumping, and nutritional deficiencies. However, this operation is still uncommon due to the perceived technical difficulty and risk of nutritional morbidity. This video demonstrates a standardized technique for this complex procedure.
RC Pullatt
Surgical intervention
10 months ago
4568 views
18 likes
4 comments
13:00
Laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
Morbid obesity has reached epidemic proportions. Biliopancreatic diversion with duodenal switch (BPD-DS) is the most effective bariatric surgery procedure for weight loss. This procedure was first described by Scopinaro in 1979. It consisted of a horizontal gastrectomy, a transection of the bowel halfway from the ligament of Treitz and the ileocecal junction, and a Roux-en-Y reconstruction with a 50cm common channel. This was later modified: the duodenal switch was added and the gastrectomy was performed in a vertical sleeve fashion, thereby preserving the pylorus and increasing the common channel to 100cm. This modification greatly reduced the incidence of marginal ulceration, dumping, and nutritional deficiencies. However, this operation is still uncommon due to the perceived technical difficulty and risk of nutritional morbidity. This video demonstrates a standardized technique for this complex procedure.
Successful closure of iatrogenic colonic perforation with Over-The-Scope Clip™ system (OVESCO™) after failed attempt with standard endoscopic clips
Iatrogenic colonic perforation is a rare complication which has been reported in 0.03%-0.8% of cases during diagnostic colonoscopy. The sigmoid colon and the rectosigmoid junction are the most common sites of perforation during diagnostic examination. Successful endoscopic closure of the defect has been reported using standard clips. However, in case of large defects, standard clips are often ineffective. OTSC™ clips are devices which are successfully used to close wall defects up to 25mm. They make it possible to continue the endoscopic procedure after wall defect closure. In this video, we show the successful closure of a sigmoid colonic iatrogenic perforation in a 50-year-old woman by means of the Over The Scope Clip™ system (OVESCO® Endoscopy, Germany) (11/6 t) after failed attempt with standard clips. OVESCO™ was applied with a standard gastroscope using the suction technique by pushing the cap against the edges of the defect. In order to prevent incarceration of adjacent structures a soft aspiration of the omentum was applied and the OVESCO™ was carefully deployed. Carbon dioxide insufflation was used. Antibiotic therapy was started and the patient was discharged 5 days later. In conclusion, the Over The Scope Clip™ (OTSC™) is a safe surgery-sparing tool which allows for a successful iatrogenic perforation closure of the GI tract, performing omentoplasty by means of a suction technique.
Gf Donatelli
Surgical intervention
4 years ago
1397 views
31 likes
0 comments
02:28
Successful closure of iatrogenic colonic perforation with Over-The-Scope Clip™ system (OVESCO™) after failed attempt with standard endoscopic clips
Iatrogenic colonic perforation is a rare complication which has been reported in 0.03%-0.8% of cases during diagnostic colonoscopy. The sigmoid colon and the rectosigmoid junction are the most common sites of perforation during diagnostic examination. Successful endoscopic closure of the defect has been reported using standard clips. However, in case of large defects, standard clips are often ineffective. OTSC™ clips are devices which are successfully used to close wall defects up to 25mm. They make it possible to continue the endoscopic procedure after wall defect closure. In this video, we show the successful closure of a sigmoid colonic iatrogenic perforation in a 50-year-old woman by means of the Over The Scope Clip™ system (OVESCO® Endoscopy, Germany) (11/6 t) after failed attempt with standard clips. OVESCO™ was applied with a standard gastroscope using the suction technique by pushing the cap against the edges of the defect. In order to prevent incarceration of adjacent structures a soft aspiration of the omentum was applied and the OVESCO™ was carefully deployed. Carbon dioxide insufflation was used. Antibiotic therapy was started and the patient was discharged 5 days later. In conclusion, the Over The Scope Clip™ (OTSC™) is a safe surgery-sparing tool which allows for a successful iatrogenic perforation closure of the GI tract, performing omentoplasty by means of a suction technique.
Case studies of complicated surgical scenarios
In this short presentation, Professor Yen-I Chen, MD, expert in advanced endoscopy and pancreaticobiliary disease at McGill University (Montreal, Canada), introduces 3 video cases of complicated surgical scenarios which were managed endoscopically.
In the first video, he presents the case of a 58 year-old man with a previous history of pancreatic cancer (2016). The patient had had a pancreaticoduodenectomy (Whipple procedure). After 2 years, the patient presented cancer recurrence with septic cholangitis due to gastrojejunostomy obstruction (closed loop obstruction of the afferent limb and also loop obstruction of the efferent limb).
In the second video, Prof. Chen looks into what can go wrong during endoscopic ultrasound-guided gastrojejunostomy. Previous stent systems required dilatations prior to stent deployment, and here, the video presents a case scenario in which the stent was displaced causing gastric perforation in the abdominal cavity. This complication was managed using a NOTES procedure.
In the third video, he reports the case of a patient with a previous obstructed duodenal stent which required an endoscopic ultrasound-guided gastrojejunostomy using the Axios stent.
YI Chen
Lecture
4 months ago
214 views
3 likes
0 comments
11:09
Case studies of complicated surgical scenarios
In this short presentation, Professor Yen-I Chen, MD, expert in advanced endoscopy and pancreaticobiliary disease at McGill University (Montreal, Canada), introduces 3 video cases of complicated surgical scenarios which were managed endoscopically.
In the first video, he presents the case of a 58 year-old man with a previous history of pancreatic cancer (2016). The patient had had a pancreaticoduodenectomy (Whipple procedure). After 2 years, the patient presented cancer recurrence with septic cholangitis due to gastrojejunostomy obstruction (closed loop obstruction of the afferent limb and also loop obstruction of the efferent limb).
In the second video, Prof. Chen looks into what can go wrong during endoscopic ultrasound-guided gastrojejunostomy. Previous stent systems required dilatations prior to stent deployment, and here, the video presents a case scenario in which the stent was displaced causing gastric perforation in the abdominal cavity. This complication was managed using a NOTES procedure.
In the third video, he reports the case of a patient with a previous obstructed duodenal stent which required an endoscopic ultrasound-guided gastrojejunostomy using the Axios stent.
Laparoscopic diamond-shaped repair of duodenal atresia
This is the case of a female newborn weighing 1080 grams, delivered at 29 weeks of gestational age due to the premature rupture of membranes. An abdominal radiography was performed in the clinical setting of non-bilious vomiting and absence of meconium passage. It revealed the double bubble sign, pathognomonic for congenital duodenal obstruction. Laparoscopy showed a type I duodenal atresia and a diamond-shaped duodenal anastomosis was performed maintaining the minimally invasive approach. Duodenal atresia represents one of the most challenging conditions for a laparoscopic skilled pediatric surgeon. This video shows that the procedure is feasible even in a low-birth-weight (LBW) premature newborn.
J Correia-Pinto, AR Silva, V Trocado
Surgical intervention
5 years ago
1139 views
31 likes
1 comment
08:31
Laparoscopic diamond-shaped repair of duodenal atresia
This is the case of a female newborn weighing 1080 grams, delivered at 29 weeks of gestational age due to the premature rupture of membranes. An abdominal radiography was performed in the clinical setting of non-bilious vomiting and absence of meconium passage. It revealed the double bubble sign, pathognomonic for congenital duodenal obstruction. Laparoscopy showed a type I duodenal atresia and a diamond-shaped duodenal anastomosis was performed maintaining the minimally invasive approach. Duodenal atresia represents one of the most challenging conditions for a laparoscopic skilled pediatric surgeon. This video shows that the procedure is feasible even in a low-birth-weight (LBW) premature newborn.
Addressing the challenges of a complicated laparoscopic cholecystectomy for cholecystitis: a live educational procedure
In this live educational video, Professor Didier Mutter provides a precise description of the most important anatomical landmarks related to cholecystectomy performed for cholecystitis. The video features a noteworthy case of fibrotic gallbladder surrounded by inflammation managed with cholecystectomy. In spite of anatomical difficulties, Professor Mutter shows how to perform a "critical view of safety", the systematization of which should be dogmatic, with complete extraction of all gallstones, in the learning process of cholecystectomy.
The author performs an outstanding standardized surgery, explaining the techniques and maneuvers to be performed in order to obtain success.
D Mutter, R Canales Cama, J Marescaux
Surgical intervention
1 month ago
2694 views
28 likes
17 comments
41:41
Addressing the challenges of a complicated laparoscopic cholecystectomy for cholecystitis: a live educational procedure
In this live educational video, Professor Didier Mutter provides a precise description of the most important anatomical landmarks related to cholecystectomy performed for cholecystitis. The video features a noteworthy case of fibrotic gallbladder surrounded by inflammation managed with cholecystectomy. In spite of anatomical difficulties, Professor Mutter shows how to perform a "critical view of safety", the systematization of which should be dogmatic, with complete extraction of all gallstones, in the learning process of cholecystectomy.
The author performs an outstanding standardized surgery, explaining the techniques and maneuvers to be performed in order to obtain success.