We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.
Filter by
Specialty
View more
Clear filter Media type
View more
Clear filter Category
View more
Publication date
Sort by:
Laparoscopic management of perforated ulcer of the stomach
A 43-year-old woman with a history of chronic use of NSAIDs was admitted to the emergency care unit for acute abdominal epigastric pain. CT-scan showed both free air and fluid in the peritoneal cavity with marked thickening and irregularity at the level of the gastric antrum and the duodenal bulb. The patient underwent emergency laparoscopy. A large amount of purulent fluid was found in the peritoneal cavity and evacuated. The gastric defect was identified at the level of the anterior wall of the gastric antrum. A 2/0 Vicryl suture is used to oversew the perforation. As an additional protection, an omental patch was brought in place and fixed against the sutured lesion. Abundant peritoneal lavage was performed. The patient was discharged on postoperative day 5. One month later, esophagogastroduodenoscopies (EGDs) with biopsies of the ulcer’s margins were performed.
X Untereiner, M Pizzicannella, B Dallemagne, D Mutter, J Marescaux
Surgical intervention
5 months ago
5019 views
14 likes
1 comment
06:55
Laparoscopic management of perforated ulcer of the stomach
A 43-year-old woman with a history of chronic use of NSAIDs was admitted to the emergency care unit for acute abdominal epigastric pain. CT-scan showed both free air and fluid in the peritoneal cavity with marked thickening and irregularity at the level of the gastric antrum and the duodenal bulb. The patient underwent emergency laparoscopy. A large amount of purulent fluid was found in the peritoneal cavity and evacuated. The gastric defect was identified at the level of the anterior wall of the gastric antrum. A 2/0 Vicryl suture is used to oversew the perforation. As an additional protection, an omental patch was brought in place and fixed against the sutured lesion. Abundant peritoneal lavage was performed. The patient was discharged on postoperative day 5. One month later, esophagogastroduodenoscopies (EGDs) with biopsies of the ulcer’s margins were performed.
Laparoscopic distal gastrectomy with Billroth II reconstruction for peptic ulcer obstruction
This live surgery video demonstrates a laparoscopic distal gastrectomy with Billroth II reconstruction in a patient with pyloric stenosis which was caused by peptic ulcer. Treatment using balloon dilatation failed. The fibrotic area of the duodenal ulcer was approached by fine dissection and ligation of right gastro-epiploic and right gastric vessels. The dissection was performed around the duodenum until an adequate margin could be obtained in the healthy portion of the distal duodenum. The duodenum was then transected by means of a stapler. A relatively large dilated stomach including the antrum and part of the gastric body was transected, and a Billroth II gastrojejunostomy was performed.
HK Yang
Surgical intervention
4 years ago
3413 views
157 likes
0 comments
21:58
Laparoscopic distal gastrectomy with Billroth II reconstruction for peptic ulcer obstruction
This live surgery video demonstrates a laparoscopic distal gastrectomy with Billroth II reconstruction in a patient with pyloric stenosis which was caused by peptic ulcer. Treatment using balloon dilatation failed. The fibrotic area of the duodenal ulcer was approached by fine dissection and ligation of right gastro-epiploic and right gastric vessels. The dissection was performed around the duodenum until an adequate margin could be obtained in the healthy portion of the distal duodenum. The duodenum was then transected by means of a stapler. A relatively large dilated stomach including the antrum and part of the gastric body was transected, and a Billroth II gastrojejunostomy was performed.
Laparoscopic management of a perforated ulcer at the gastrojejunal anastomosis after LGBP
Anastomotic ulcers (also known as ‘‘marginal’’ ulcers) develop as a complication of Roux-en-Y gastric bypass for treatment of obesity, they are almost always found to arise in the jejunal Roux limb directly abutting the gastrojejunal anastomosis. Marginal ulcers have been reported in 1–16% of patients after gastric bypass surgery, developing in both the early and late postoperative periods.
Recommended references:
1. Sapala JA, Wood MH, Sapala MA, Flake TM Jr. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 1998;8:505–516.
2. Csendes A, Burgos AM, Altuve J, Bonacic S. Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg 2009;19:135–138.
3. Patel RA, Brolin RE, Gandhi A. Revisional operations for marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009;5:317–322.
4. St. Jean MR, Dunkle-Blatter SE, Petrick AT. Laparoscopic management of perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2:668.
5. Goitein D. Late perforation of the jejuno-jejunal anastomosis after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2005;13(6):880–882.
V Podelski, L Marx, J Marescaux
Surgical intervention
7 years ago
3193 views
63 likes
0 comments
05:30
Laparoscopic management of a perforated ulcer at the gastrojejunal anastomosis after LGBP
Anastomotic ulcers (also known as ‘‘marginal’’ ulcers) develop as a complication of Roux-en-Y gastric bypass for treatment of obesity, they are almost always found to arise in the jejunal Roux limb directly abutting the gastrojejunal anastomosis. Marginal ulcers have been reported in 1–16% of patients after gastric bypass surgery, developing in both the early and late postoperative periods.
Recommended references:
1. Sapala JA, Wood MH, Sapala MA, Flake TM Jr. Marginal ulcer after gastric bypass: a prospective 3-year study of 173 patients. Obes Surg 1998;8:505–516.
2. Csendes A, Burgos AM, Altuve J, Bonacic S. Incidence of marginal ulcer 1 month and 1 to 2 years after gastric bypass: a prospective consecutive endoscopic evaluation of 442 patients with morbid obesity. Obes Surg 2009;19:135–138.
3. Patel RA, Brolin RE, Gandhi A. Revisional operations for marginal ulcer after Roux-en-Y gastric bypass. Surg Obes Relat Dis 2009;5:317–322.
4. St. Jean MR, Dunkle-Blatter SE, Petrick AT. Laparoscopic management of perforated marginal ulcer after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 2006;2:668.
5. Goitein D. Late perforation of the jejuno-jejunal anastomosis after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2005;13(6):880–882.
Robotic distal gastrectomy with the EndoWrist® One Vessel Sealer
The EndoWrist® One vessel sealer is a wristed, single-use instrument of the da Vinci surgical robotic system intended for bipolar coagulation and mechanical transection of vessels up to 7mm in diameter and tissue bundles. It could be a potential instrument to overcome the limitation of straight energy-based devices. Although it has the advantage of having an endowrist function which allows easy access to the surgical planes in ideal directions, it requires special caution and know-how to use the device safely and effectively, because of a relatively blunt tip and the absence of an active blade at the tip.
This video of the robotic distal gastrectomy for early gastric cancer shows how to harmonize the use of a sharp instrument with conventional bipolar electricity and of the vessel sealer device to maximize the advantages of such devices and to ensure safety. A conventional bipolar forceps is used to make entrance holes on the tissue for a safe application of the vessel sealer, and to perform fine dissections of small tissues, which are difficult to manage using a vessel sealer. Once the access hole has been made, the vessel sealer is applied in an ideal axis to the avascular tissue plane, thanks to the free wrist function. This technique combined with a sharp instrument using conventional bipolar electricity seems to be helpful for a safe and effective operation, which can use the benefit of the vessel sealer to its full potential, for instance with a high degree of freedom of the movement and secure sealing of lymphovascular structures.
HK Yang, SH Kong
Surgical intervention
3 years ago
1390 views
81 likes
0 comments
10:38
Robotic distal gastrectomy with the EndoWrist® One Vessel Sealer
The EndoWrist® One vessel sealer is a wristed, single-use instrument of the da Vinci surgical robotic system intended for bipolar coagulation and mechanical transection of vessels up to 7mm in diameter and tissue bundles. It could be a potential instrument to overcome the limitation of straight energy-based devices. Although it has the advantage of having an endowrist function which allows easy access to the surgical planes in ideal directions, it requires special caution and know-how to use the device safely and effectively, because of a relatively blunt tip and the absence of an active blade at the tip.
This video of the robotic distal gastrectomy for early gastric cancer shows how to harmonize the use of a sharp instrument with conventional bipolar electricity and of the vessel sealer device to maximize the advantages of such devices and to ensure safety. A conventional bipolar forceps is used to make entrance holes on the tissue for a safe application of the vessel sealer, and to perform fine dissections of small tissues, which are difficult to manage using a vessel sealer. Once the access hole has been made, the vessel sealer is applied in an ideal axis to the avascular tissue plane, thanks to the free wrist function. This technique combined with a sharp instrument using conventional bipolar electricity seems to be helpful for a safe and effective operation, which can use the benefit of the vessel sealer to its full potential, for instance with a high degree of freedom of the movement and secure sealing of lymphovascular structures.
Transumbilical single-access perforated gastric ulcer repair
Background: Single-access laparoscopy (SAL) can be proposed in patients presenting peritonitis both for diagnosis and treatment. This video shows a transumbilical SAL performed for perforated gastric ulcer.

Video: A 30 year-old woman with a body mass index of 22.9 kg/m2 was admitted to the emergency room for diffuse abdominal pain. Preoperative work-up showed a pneumoperitoneum, hence a SAL was proposed to the patient. The procedure was performed using a standard 11mm reusable trocar for a 10mm, standard length, 30-degree scope, and curved reusable instruments inserted transumbilically without trocars. The cavity exploration showed a perforated gastric ulcer at the anterior surface of the prepyloric area. A suture repair, omentoplasty and lavage of the cavity was performed.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 108 minutes and laparoscopic time 86 minutes. Final umbilical incision length was 15mm. The patient’s pain medication could be kept low and the patient was allowed to be discharged on the 5th postoperative day. After 6 months, the patient was well with no visible umbilical scar.

Conclusion: Transumbilical SAL can be proposed in selected patients for suspicion of perforated gastric ulcer, with the main advantage of cosmetic result.
G Dapri, J Himpens, GB Cadière
Surgical intervention
7 years ago
3842 views
50 likes
0 comments
05:17
Transumbilical single-access perforated gastric ulcer repair
Background: Single-access laparoscopy (SAL) can be proposed in patients presenting peritonitis both for diagnosis and treatment. This video shows a transumbilical SAL performed for perforated gastric ulcer.

Video: A 30 year-old woman with a body mass index of 22.9 kg/m2 was admitted to the emergency room for diffuse abdominal pain. Preoperative work-up showed a pneumoperitoneum, hence a SAL was proposed to the patient. The procedure was performed using a standard 11mm reusable trocar for a 10mm, standard length, 30-degree scope, and curved reusable instruments inserted transumbilically without trocars. The cavity exploration showed a perforated gastric ulcer at the anterior surface of the prepyloric area. A suture repair, omentoplasty and lavage of the cavity was performed.

Results: No conversion to open surgery or additional trocars were necessary. Total operative time was 108 minutes and laparoscopic time 86 minutes. Final umbilical incision length was 15mm. The patient’s pain medication could be kept low and the patient was allowed to be discharged on the 5th postoperative day. After 6 months, the patient was well with no visible umbilical scar.

Conclusion: Transumbilical SAL can be proposed in selected patients for suspicion of perforated gastric ulcer, with the main advantage of cosmetic result.
Laparoscopic antrectomy and vagotomy for stenotic pyloric peptic ulcer
Peptic ulcer disease is the major cause of benign gastro-duodenal obstruction or gastric outlet obstruction (GOO) in the adult population. Patients often present with abdominal pain and distension, vomiting, dehydration, and weight loss. Previous studies have demonstrated that the incidence of GOO varies from 5% to 10% of all hospital admissions for ulcer-related complications.
Today surgeons are performing fewer elective ulcer surgeries, as H2 receptor blockers and the eradication of Helicobacter pylori represent a major step in the treatment of this disease. Nevertheless, patients with complications and those resistant to medical therapy can be offered surgical options. When surgery is required, a laparoscopic approach is possible with its well-known advantages.
Surgical procedures include highly selective vagotomy with some form of pyloroplasty, truncal vagotomy and antrectomy, and truncal vagotomy with gastroenterostomy. Proponents of highly selective vagotomy advocate an acceptably low recurrence rate (0 to 5% at follow-up of 24 to 90 months) and a relative paucity of post-gastrectomy sequelae. Those recommending vagotomy and antrectomy stress the superiority of the acid-reducing procedure, the virtual absence of recurrent ulceration, and the rarity of postoperative symptoms other than post-vagotomy diarrhea, which is usually a self-limited process. Finally, truncal vagotomy with gastroenterostomy avoids what can be a treacherous duodenal stump, but can result in higher ulcer recurrence rates.
We present the case of a young male patient not compliant to medical treatment who was referred to us for gastric outlet obstruction. The selected approach consisted in a laparoscopic Billroth II antrectomy and vagotomy using four ports.
B Dallemagne, S Perretta, J Marescaux
Surgical intervention
10 years ago
1525 views
160 likes
0 comments
12:58
Laparoscopic antrectomy and vagotomy for stenotic pyloric peptic ulcer
Peptic ulcer disease is the major cause of benign gastro-duodenal obstruction or gastric outlet obstruction (GOO) in the adult population. Patients often present with abdominal pain and distension, vomiting, dehydration, and weight loss. Previous studies have demonstrated that the incidence of GOO varies from 5% to 10% of all hospital admissions for ulcer-related complications.
Today surgeons are performing fewer elective ulcer surgeries, as H2 receptor blockers and the eradication of Helicobacter pylori represent a major step in the treatment of this disease. Nevertheless, patients with complications and those resistant to medical therapy can be offered surgical options. When surgery is required, a laparoscopic approach is possible with its well-known advantages.
Surgical procedures include highly selective vagotomy with some form of pyloroplasty, truncal vagotomy and antrectomy, and truncal vagotomy with gastroenterostomy. Proponents of highly selective vagotomy advocate an acceptably low recurrence rate (0 to 5% at follow-up of 24 to 90 months) and a relative paucity of post-gastrectomy sequelae. Those recommending vagotomy and antrectomy stress the superiority of the acid-reducing procedure, the virtual absence of recurrent ulceration, and the rarity of postoperative symptoms other than post-vagotomy diarrhea, which is usually a self-limited process. Finally, truncal vagotomy with gastroenterostomy avoids what can be a treacherous duodenal stump, but can result in higher ulcer recurrence rates.
We present the case of a young male patient not compliant to medical treatment who was referred to us for gastric outlet obstruction. The selected approach consisted in a laparoscopic Billroth II antrectomy and vagotomy using four ports.
Gastrectomy for benign lesions: classic partial gastrectomy, variation: antrectomy
The description of the classic partial gastrectomy for benign lesions and its variation: antrectomy covers all aspects of the surgical procedure used for the management of benign gastric tumors.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: surgical approach, principles, mobilization of greater curvature, mobilization/transection, gastrojejunal anastomosis, gastroduodenal anastomosis, difficult duodenums, freeing of the curvature, transection of the stomach, restoration/continuity, Billroth I anastomosis, Billroth II anastomosis.
Consequently, this operating technique is well standardized for the management of this condition.
D Mutter
Operative technique
17 years ago
2806 views
147 likes
0 comments
Gastrectomy for benign lesions: classic partial gastrectomy, variation: antrectomy
The description of the classic partial gastrectomy for benign lesions and its variation: antrectomy covers all aspects of the surgical procedure used for the management of benign gastric tumors.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: surgical approach, principles, mobilization of greater curvature, mobilization/transection, gastrojejunal anastomosis, gastroduodenal anastomosis, difficult duodenums, freeing of the curvature, transection of the stomach, restoration/continuity, Billroth I anastomosis, Billroth II anastomosis.
Consequently, this operating technique is well standardized for the management of this condition.
Technique: laparoscopic distal gastrectomy
The description of the technique of laparoscopic distal gastrectomy covers all aspects of the surgical procedure used for the management of chronic gastric ulcers.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: surgical procedure, exploration, dissection of greater curvature, resection of the antrum, gastroduodenal anastomosis, Billroth II anastomosis, complications, intraoperative complications, postoperative complications, functional complications.
Consequently, this operating technique is well standardized for the management of this condition.
D Mutter
Operative technique
18 years ago
3763 views
124 likes
0 comments
Technique: laparoscopic distal gastrectomy
The description of the technique of laparoscopic distal gastrectomy covers all aspects of the surgical procedure used for the management of chronic gastric ulcers.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: surgical procedure, exploration, dissection of greater curvature, resection of the antrum, gastroduodenal anastomosis, Billroth II anastomosis, complications, intraoperative complications, postoperative complications, functional complications.
Consequently, this operating technique is well standardized for the management of this condition.