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Laparoscopic management of small bowel obstruction and ileo-ileal intussusception
Meckel’s diverticulum is the most common congenital anomaly of the digestive tract, found in 2 to 3% of the population. It is usually detected in children. In adults, symptoms vary, and diagnosis is therefore uneasy to establish. The most common infectious complications include obstructions and bleedings, which account for approximately one third of overall complications. Obstructions may be caused by intussusception or by a band.
This video demonstrates a case of a 49-year-old male patient, who necessitated an emergency surgical procedure for the management of a small bowel obstruction induced by the presence of Meckel’s diverticulum and intussusception. Due to an underlying necrosis, a resection and an anastomosis of the small bowel were performed.
D Kadoche, M Ignat, D Mutter, J Marescaux
Surgical intervention
6 months ago
652 views
4 likes
0 comments
08:22
Laparoscopic management of small bowel obstruction and ileo-ileal intussusception
Meckel’s diverticulum is the most common congenital anomaly of the digestive tract, found in 2 to 3% of the population. It is usually detected in children. In adults, symptoms vary, and diagnosis is therefore uneasy to establish. The most common infectious complications include obstructions and bleedings, which account for approximately one third of overall complications. Obstructions may be caused by intussusception or by a band.
This video demonstrates a case of a 49-year-old male patient, who necessitated an emergency surgical procedure for the management of a small bowel obstruction induced by the presence of Meckel’s diverticulum and intussusception. Due to an underlying necrosis, a resection and an anastomosis of the small bowel were performed.
Minimally invasive surgical approach to small bowel obstruction
Due to the lack of laparoscopic experience to work in a small space (small bowel distension), small bowel obstruction seems to be a relative contraindication for a minimally invasive approach. In other hands, many patients have co-morbidities, and consequently it is key to work with a low intra-abdominal pressure to prevent any conversion for pneumoperitoneum intolerance. Small bowel obstruction must be resolved by experts in order to prevent any excessive mobilization and iatrogenic perforation.

Critical comments:
This video presents the laparoscopic management of bowel obstruction. It demonstrates the feasibility of the identification and management of mechanical bowel obstruction. Several parts of the video can be discussed:
1. In their comments, the authors report that the whole bowel has to be explored in order to prevent the presence of a secondary band at the origin of the obstruction. This is absolutely mandatory. Usually, the recommendation is to start the exploration at the level of the caecum and to mobilize the whole non-dilated bowel in order to prevent a risk of bowel injury during this manipulation. Exploration of the dilated bowel is much more risky. The authors did not show this extensive and systematic exploration.
2. The authors reported that they used 5 to 10 liters of warm saline for abdominal lavage. Today, there is no evidence of the benefit of this major abdominal lavage including 5 to 10 liters. Selective lavage can be recommended in case of significant bacterial contamination.
3. The authors consider the potential benefit of irrigation of the ischemic bowel with hot water after band division. This indication can be considered as potentially efficient regarding the recommendations in open surgery. However, laparoscopy has a significant advantage to keep the internal temperature of 37°C at a minimum, and certainly hot lavage, which cannot be over 39°C to 40°C, will probably also have limited impact.
Despite these minor remarks, this video has a scientific value in demonstrating a safe approach to a small bowel obstruction related to a single band, which is, in this case, very safely resected.
One can also focus on the value of working with a high quality camera, which gives the surgeon the possibility to clearly evaluate the vitality of the small bowel after an ischemic period, which is well demonstrated in this video.
S Rua, F Silveira, P Mira
Surgical intervention
3 years ago
1321 views
60 likes
0 comments
06:59
Minimally invasive surgical approach to small bowel obstruction
Due to the lack of laparoscopic experience to work in a small space (small bowel distension), small bowel obstruction seems to be a relative contraindication for a minimally invasive approach. In other hands, many patients have co-morbidities, and consequently it is key to work with a low intra-abdominal pressure to prevent any conversion for pneumoperitoneum intolerance. Small bowel obstruction must be resolved by experts in order to prevent any excessive mobilization and iatrogenic perforation.

Critical comments:
This video presents the laparoscopic management of bowel obstruction. It demonstrates the feasibility of the identification and management of mechanical bowel obstruction. Several parts of the video can be discussed:
1. In their comments, the authors report that the whole bowel has to be explored in order to prevent the presence of a secondary band at the origin of the obstruction. This is absolutely mandatory. Usually, the recommendation is to start the exploration at the level of the caecum and to mobilize the whole non-dilated bowel in order to prevent a risk of bowel injury during this manipulation. Exploration of the dilated bowel is much more risky. The authors did not show this extensive and systematic exploration.
2. The authors reported that they used 5 to 10 liters of warm saline for abdominal lavage. Today, there is no evidence of the benefit of this major abdominal lavage including 5 to 10 liters. Selective lavage can be recommended in case of significant bacterial contamination.
3. The authors consider the potential benefit of irrigation of the ischemic bowel with hot water after band division. This indication can be considered as potentially efficient regarding the recommendations in open surgery. However, laparoscopy has a significant advantage to keep the internal temperature of 37°C at a minimum, and certainly hot lavage, which cannot be over 39°C to 40°C, will probably also have limited impact.
Despite these minor remarks, this video has a scientific value in demonstrating a safe approach to a small bowel obstruction related to a single band, which is, in this case, very safely resected.
One can also focus on the value of working with a high quality camera, which gives the surgeon the possibility to clearly evaluate the vitality of the small bowel after an ischemic period, which is well demonstrated in this video.
Acute small bowel ischemia: laparoscopic exploration and treatment
We present the case of a 63-year-old male patient admitted to the emergency department with severe acute abdominal pain unresponsive to symptomatic treatment. The clinical examination revealed a generalized peritoneal reaction. The diagnosis of small bowel ischemia with free peritoneal fluid without occlusion of the superior mesenteric artery (SMA) or the superior mesenteric vein (SMV) was established by means of a contrast injected CT-scan.
A laparoscopic exploration allowed to discover a segmental small bowel ischemic necrosis with severe hemorrhagic congestion of the bowel wall. After verifying that the rest of the small bowel and the colon were viable, a laparoscopic resection was performed with an intracorporeal side-to-side anastomosis. The postoperative course was uneventful with patient discharge on day 4.
Pathological examination confirmed that the resected segment of 92cm had ischemia of the mucosa and of the serosa with intensive congestion and hemorrhagic effusion. The patient’s one-month follow-up was uneventful. A programmed cardiological, hematological and immunological consultation and work-up to look for thrombotic risk factors was negative.
Acute small bowel ischemia is an unusual cause of acute abdomen that is difficult to diagnose due to its non-specific clinical signs. Clinical suspicion is warranted in patients with a past history of cardiovascular thrombotic conditions or hypercoagulable states. In 50% of cases, it is caused by arterial obstruction, in 20 to 30% of cases by non-occlusive arterial ischemia, and by venous occlusion [1] in 5 to 15% of cases. It has a high mortality rate of 59 to 93% and patient survival is highly dependent on a timely diagnosis and treatment. The European Association for Endoscopic Surgery (EAES) consensus for the laparoscopic approach to the acute abdomen states that there is no published data demonstrating advantages in the diagnosis and treatment of acute bowel ischemia by laparoscopy [2]. However, laparoscopy may prove beneficial in confirming the diagnosis in doubtful cases, calculate the extension of the ischemic small bowel segment, and offer a treatment option in cases of segmental necrosis.
1. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology 2000;118:954-68.
2. Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012;26:2134-64.
D Ntourakis, D Mutter, J Marescaux
Surgical intervention
4 years ago
2326 views
68 likes
0 comments
19:57
Acute small bowel ischemia: laparoscopic exploration and treatment
We present the case of a 63-year-old male patient admitted to the emergency department with severe acute abdominal pain unresponsive to symptomatic treatment. The clinical examination revealed a generalized peritoneal reaction. The diagnosis of small bowel ischemia with free peritoneal fluid without occlusion of the superior mesenteric artery (SMA) or the superior mesenteric vein (SMV) was established by means of a contrast injected CT-scan.
A laparoscopic exploration allowed to discover a segmental small bowel ischemic necrosis with severe hemorrhagic congestion of the bowel wall. After verifying that the rest of the small bowel and the colon were viable, a laparoscopic resection was performed with an intracorporeal side-to-side anastomosis. The postoperative course was uneventful with patient discharge on day 4.
Pathological examination confirmed that the resected segment of 92cm had ischemia of the mucosa and of the serosa with intensive congestion and hemorrhagic effusion. The patient’s one-month follow-up was uneventful. A programmed cardiological, hematological and immunological consultation and work-up to look for thrombotic risk factors was negative.
Acute small bowel ischemia is an unusual cause of acute abdomen that is difficult to diagnose due to its non-specific clinical signs. Clinical suspicion is warranted in patients with a past history of cardiovascular thrombotic conditions or hypercoagulable states. In 50% of cases, it is caused by arterial obstruction, in 20 to 30% of cases by non-occlusive arterial ischemia, and by venous occlusion [1] in 5 to 15% of cases. It has a high mortality rate of 59 to 93% and patient survival is highly dependent on a timely diagnosis and treatment. The European Association for Endoscopic Surgery (EAES) consensus for the laparoscopic approach to the acute abdomen states that there is no published data demonstrating advantages in the diagnosis and treatment of acute bowel ischemia by laparoscopy [2]. However, laparoscopy may prove beneficial in confirming the diagnosis in doubtful cases, calculate the extension of the ischemic small bowel segment, and offer a treatment option in cases of segmental necrosis.
1. Brandt LJ, Boley SJ. AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology 2000;118:954-68.
2. Agresta F, Ansaloni L, Baiocchi GL, Bergamini C, Campanile FC, Carlucci M, Cocorullo G, Corradi A, Franzato B, Lupo M, Mandalà V, Mirabella A, Pernazza G, Piccoli M, Staudacher C, Vettoretto N, Zago M, Lettieri E, Levati A, Pietrini D, Scaglione M, De Masi S, De Placido G, Francucci M, Rasi M, Fingerhut A, Uranüs S, Garattini S. Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d'Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell'Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES). Surg Endosc 2012;26:2134-64.
Acute small bowel obstruction two months after laparoscopic rectal prolapse surgery: laparoscopic management
Acute small bowel obstruction (SBO) is an ever-increasing clinical problem. In this video, the authors demonstrate the laparoscopic management of acute small bowel obstruction. Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills. The adoption of laparoscopy in the treatment of SBO has been slow because of concerns for iatrogenic bowel injury and working space issues related to bowel distension.
In this film, the authors demonstrate that it is essential to rapidly manage the patient after the first acute attack.
Although there is an inherent appeal for laparoscopy in its potential to minimize short- and long-term wound complications and perioperative laparotomy-related morbidity and to theoretically induce fewer subsequent adhesions than a traditional laparotomy incision would.

Small bowel obstruction is a pathology commonly found in the current practice of surgical emergencies. The main cause stems from surgical history with a variable onset of symptoms. The introduction of laparoscopic surgery helped to slightly reduce the number of patients presenting with occlusive syndromes. The rapid management of occlusive patients is one of the keys to success. Consequently, once diagnosis has been evoked, imaging studies must be performed, and especially CT-scan, in order to determine the type of obstruction, its mechanism and its severity. After work-up, either a conservative medical treatment or surgery will be decided upon.
L Marx, J Leroy, J Marescaux
Surgical intervention
6 years ago
2990 views
20 likes
0 comments
04:19
Acute small bowel obstruction two months after laparoscopic rectal prolapse surgery: laparoscopic management
Acute small bowel obstruction (SBO) is an ever-increasing clinical problem. In this video, the authors demonstrate the laparoscopic management of acute small bowel obstruction. Its successful management depends on a comprehensive knowledge of the etiology and pathophysiology of obstruction, familiarity with imaging methods, good clinical judgment, and sound technical skills. The adoption of laparoscopy in the treatment of SBO has been slow because of concerns for iatrogenic bowel injury and working space issues related to bowel distension.
In this film, the authors demonstrate that it is essential to rapidly manage the patient after the first acute attack.
Although there is an inherent appeal for laparoscopy in its potential to minimize short- and long-term wound complications and perioperative laparotomy-related morbidity and to theoretically induce fewer subsequent adhesions than a traditional laparotomy incision would.

Small bowel obstruction is a pathology commonly found in the current practice of surgical emergencies. The main cause stems from surgical history with a variable onset of symptoms. The introduction of laparoscopic surgery helped to slightly reduce the number of patients presenting with occlusive syndromes. The rapid management of occlusive patients is one of the keys to success. Consequently, once diagnosis has been evoked, imaging studies must be performed, and especially CT-scan, in order to determine the type of obstruction, its mechanism and its severity. After work-up, either a conservative medical treatment or surgery will be decided upon.
Small bowel obstruction and ileal strangulation by adhesions: role of laparoscopy in early diagnosis and treatment
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, most frequently caused by adhesions. In the absence of signs of strangulations or CT-scan evidence (free fluid mesenteric edema, “small bowel faeces” sign, devascularization), a large portion of ASBO can be resolved using non-operative methods even if a significant number of patients will require an emergency surgery.
Laparoscopy in acute care surgery continues to expand even in cases of small bowel obstruction which were conventionally managed by means of laparotomy.
The authors report a case of a 45-year-old woman, completely laparoscopically treated, with a history of previous appendectomy with pelvic abscess, cholecystectomy and removal of right ovarian cysts. She was admitted to the emergency room five hours before surgery with severe acute abdominal pain which appeared 24 hours before.
CT-scan with oral administration of gastrografin showed signs of intestinal obstruction and adhesions were suspected. The exploratory laparoscopy revealed adhesive small bowel obstruction with ileal strangulation. The intestine was viable and resection was unnecessary.
The role of diagnostic imaging modalities is relevant to decrease ASBO-related morbidity and mortality. However, because of the lack of specific radiological signs and laboratory findings of bowel strangulation, the diagnosis requires, when it is not contraindicated, a timely laparoscopic exploration with both diagnostic and therapeutic purposes.
V Guarino, A Cappiello, N Perrotta, A Scotti, F Mastellone, D Loffredo
Surgical intervention
3 years ago
1917 views
87 likes
0 comments
08:20
Small bowel obstruction and ileal strangulation by adhesions: role of laparoscopy in early diagnosis and treatment
Adhesive small bowel obstruction (ASBO) is a common surgical emergency, most frequently caused by adhesions. In the absence of signs of strangulations or CT-scan evidence (free fluid mesenteric edema, “small bowel faeces” sign, devascularization), a large portion of ASBO can be resolved using non-operative methods even if a significant number of patients will require an emergency surgery.
Laparoscopy in acute care surgery continues to expand even in cases of small bowel obstruction which were conventionally managed by means of laparotomy.
The authors report a case of a 45-year-old woman, completely laparoscopically treated, with a history of previous appendectomy with pelvic abscess, cholecystectomy and removal of right ovarian cysts. She was admitted to the emergency room five hours before surgery with severe acute abdominal pain which appeared 24 hours before.
CT-scan with oral administration of gastrografin showed signs of intestinal obstruction and adhesions were suspected. The exploratory laparoscopy revealed adhesive small bowel obstruction with ileal strangulation. The intestine was viable and resection was unnecessary.
The role of diagnostic imaging modalities is relevant to decrease ASBO-related morbidity and mortality. However, because of the lack of specific radiological signs and laboratory findings of bowel strangulation, the diagnosis requires, when it is not contraindicated, a timely laparoscopic exploration with both diagnostic and therapeutic purposes.
Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
P Leão, H Cristino, JP Pinto
Surgical intervention
2 years ago
1365 views
95 likes
0 comments
04:09
Laparoscopic treatment of a giant mesenteric cyst
Mesenteric cysts are very rare entities (annually worldwide estimated incidence of 1/140 000 inhabitants). They do not have pathognomonic features and require a differential diagnosis with lymphangiomas, sarcomas, adenocarcinomas, and intestinal duplications. They typically appear more in women (twice the incidence) and are mostly benign swellings (malignancy rate of about 3%). The gold standard treatment is laparoscopic surgical resection.
The case is that of a 49-year-old female patient referred for an abdominal swelling in the periumbilical region, which was uncomfortable for the patient, namely in the contraction of the abdominals. She did not describe any changes in intestinal transit, anorexia, asthenia or associated weight loss. The imaging study by computer tomography documented a "cystic lesion of 13cm in the root of the mesentery in contact with great vessels and duodenum". The patient was resected laparoscopically in March 2016, discharged on the second postoperative day, without intercurrences. The video of the mesenteric cyst excision surgery demonstrates some of the risks of the laparoscopic approach of the mesentery and underlines the possibility of dissection of these cysts even when they are giant cysts and in close relation with vital structures such as the vena cava and the iliac arteries.
Suprapubic single incision laparoscopic segmental small bowel resection including 3 different intracorporeal anastomoses
Background: Single incision laparoscopy (SIL) can be offered to young ladies presenting with malignant digestive tumors since they can undergo surgery through a suprapubic access, with a final non-visible result because it is under the bikini line.
Video: A 40-year-old woman presenting with an unknown anemia was admitted to our department. Preoperative work-up evidenced an adenocarcinoma of the small bowel at 120cm from the pylorus. A suprapubic SIL segmental small bowel resection was proposed to the patient. The procedure was performed with the surgeon standing between the patient’s legs, using three reusable ports placed above the pubic bone. Curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) allowed surgeons to work in good ergonomic conditions, maintaining a low cost for SIL. For the insertion of the linear stapler, a temporary 5mm scope was used and the intestinal continuity was established by a completely intracorporeal manual end-to-end anastomosis. Another option is to perform a completely intracorporeal manual end-to-side anastomosis (especially in case of obstructive tumor) or a linear mechanical side-to-side anastomosis. The mesenteric window was closed. The specimen was extracted suprapubically with a wound protection once the three windows of the ports have been joined together.
Results: Laparoscopy took 160 minutes and perioperative bleeding was 20cc. No postoperative complications were noted and the use of minimal pain killers allowed for patient discharge after four days. Pathological findings demonstrated a poorly differentiated adenocarcinoma of the jejunum, with 17 negative nodes (pT3N0Mx). The postoperative follow-up, including blood tests and PET-scan, did not show any recurrence at 12 months.
Conclusions: In addition to the known advantages of conventional multiport laparoscopy, the SIL technique allows to offer satisfying oncological results in addition to a non-visible surgical scar, because it is localized under the bikini line. Additionally, abdominal trauma and the final scar length can be reduced, since they are related to the tumor’s size.
G Dapri, K Grozdev, GB Cadière
Surgical intervention
4 years ago
906 views
23 likes
0 comments
11:21
Suprapubic single incision laparoscopic segmental small bowel resection including 3 different intracorporeal anastomoses
Background: Single incision laparoscopy (SIL) can be offered to young ladies presenting with malignant digestive tumors since they can undergo surgery through a suprapubic access, with a final non-visible result because it is under the bikini line.
Video: A 40-year-old woman presenting with an unknown anemia was admitted to our department. Preoperative work-up evidenced an adenocarcinoma of the small bowel at 120cm from the pylorus. A suprapubic SIL segmental small bowel resection was proposed to the patient. The procedure was performed with the surgeon standing between the patient’s legs, using three reusable ports placed above the pubic bone. Curved reusable instruments according to DAPRI (Karl Storz Endoskope, Tuttlingen, Germany) allowed surgeons to work in good ergonomic conditions, maintaining a low cost for SIL. For the insertion of the linear stapler, a temporary 5mm scope was used and the intestinal continuity was established by a completely intracorporeal manual end-to-end anastomosis. Another option is to perform a completely intracorporeal manual end-to-side anastomosis (especially in case of obstructive tumor) or a linear mechanical side-to-side anastomosis. The mesenteric window was closed. The specimen was extracted suprapubically with a wound protection once the three windows of the ports have been joined together.
Results: Laparoscopy took 160 minutes and perioperative bleeding was 20cc. No postoperative complications were noted and the use of minimal pain killers allowed for patient discharge after four days. Pathological findings demonstrated a poorly differentiated adenocarcinoma of the jejunum, with 17 negative nodes (pT3N0Mx). The postoperative follow-up, including blood tests and PET-scan, did not show any recurrence at 12 months.
Conclusions: In addition to the known advantages of conventional multiport laparoscopy, the SIL technique allows to offer satisfying oncological results in addition to a non-visible surgical scar, because it is localized under the bikini line. Additionally, abdominal trauma and the final scar length can be reduced, since they are related to the tumor’s size.
Laparoscopic management of small bowel perforation induced by foreign body
Ingested foreign bodies are a common cause for emergency hospital admission. A precise interview of the patient often allows to establish the diagnosis. In 90% of cases, the foreign body is spontaneously eliminated without inducing any particular symptoms. In less than 10% of cases, it requires non-surgical extraction maneuvers (enemas, endoscopy). Only 1% of cases are treated surgically. Modern imaging frequently allows to establish a precise topographic diagnosis based on aspect, size and density. Coupled with laparoscopic surgery, it allows for an early, targeted and minimally invasive management. In this video, we show the case of a patient presenting with typical signs of peritonitis along with the incidental discovery of an intraluminal foreign body in the small bowel which brought about a micro-perforation.
L Marx, M Raharimanantsoa, J Marescaux
Surgical intervention
6 years ago
1835 views
12 likes
0 comments
10:15
Laparoscopic management of small bowel perforation induced by foreign body
Ingested foreign bodies are a common cause for emergency hospital admission. A precise interview of the patient often allows to establish the diagnosis. In 90% of cases, the foreign body is spontaneously eliminated without inducing any particular symptoms. In less than 10% of cases, it requires non-surgical extraction maneuvers (enemas, endoscopy). Only 1% of cases are treated surgically. Modern imaging frequently allows to establish a precise topographic diagnosis based on aspect, size and density. Coupled with laparoscopic surgery, it allows for an early, targeted and minimally invasive management. In this video, we show the case of a patient presenting with typical signs of peritonitis along with the incidental discovery of an intraluminal foreign body in the small bowel which brought about a micro-perforation.
Laparoscopic treatment of acute small bowel obstruction: multiple cases of laparoscopic adhesiolysis
The video shows the laparoscopic management of three separate cases of acute small bowel obstruction secondary to adhesions. The difficulties and advantages of such an approach in this emergency scenario are discussed.
The author begins by inserting a trocar in the umbilicus. Upon exploration of the abdominal cavity, intestinal obstruction becomes clearly evident from the presence of dilated loops and flattened, collapsed loops. The author follows the collapsed loops until the transition zone is identified. The adhesions appear between the greater omentum and the mesentery. This band is divided. Further exploration leads to the finding of a second adhesion. This area shows no signs of occlusion. The author divides this adhesion. Exploration of the remainder of the small bowel continues to rule out further adhesions.
F Costantino, J Marescaux
Surgical intervention
11 years ago
3957 views
45 likes
0 comments
09:41
Laparoscopic treatment of acute small bowel obstruction: multiple cases of laparoscopic adhesiolysis
The video shows the laparoscopic management of three separate cases of acute small bowel obstruction secondary to adhesions. The difficulties and advantages of such an approach in this emergency scenario are discussed.
The author begins by inserting a trocar in the umbilicus. Upon exploration of the abdominal cavity, intestinal obstruction becomes clearly evident from the presence of dilated loops and flattened, collapsed loops. The author follows the collapsed loops until the transition zone is identified. The adhesions appear between the greater omentum and the mesentery. This band is divided. Further exploration leads to the finding of a second adhesion. This area shows no signs of occlusion. The author divides this adhesion. Exploration of the remainder of the small bowel continues to rule out further adhesions.
Explorative laparoscopy: resection of small bowel for vascular tumor
The management of patients with small bowel bleeding remains a diagnostic and therapeutic challenge. In about 5% of cases, upper endoscopy and colonoscopy are nondiagnostic, and the small intestine is the site of bleeding,
This is the case of a 55-year-old patient admitted to the emergency department for a digestive hemorrhagic syndrome. The patient’s hemoglobin levels dropped to 6 grams per 100mL. The patient’s resuscitation allowed for the stabilization and restoration of blood volume.
Gastroscopy and colonoscopy did not demonstrate any etiology of bleeding. An emergency CT-scan found a suspected lesion at the level of the small bowel with contrast medium extravasation.
A video-endoscopic capsule was administered to the patient. It helped to identify the presence of a bleeding polypoid lesion on the middle portion of the jejunum. This video shows the laparoscopid resection of the lesion.
M Vix, J Marescaux
Surgical intervention
7 years ago
1852 views
14 likes
0 comments
11:59
Explorative laparoscopy: resection of small bowel for vascular tumor
The management of patients with small bowel bleeding remains a diagnostic and therapeutic challenge. In about 5% of cases, upper endoscopy and colonoscopy are nondiagnostic, and the small intestine is the site of bleeding,
This is the case of a 55-year-old patient admitted to the emergency department for a digestive hemorrhagic syndrome. The patient’s hemoglobin levels dropped to 6 grams per 100mL. The patient’s resuscitation allowed for the stabilization and restoration of blood volume.
Gastroscopy and colonoscopy did not demonstrate any etiology of bleeding. An emergency CT-scan found a suspected lesion at the level of the small bowel with contrast medium extravasation.
A video-endoscopic capsule was administered to the patient. It helped to identify the presence of a bleeding polypoid lesion on the middle portion of the jejunum. This video shows the laparoscopid resection of the lesion.
Three-trocar laparoscopic right ileocolectomy for advanced small bowel neuroendocrine tumor
Background: Minimally invasive surgery (MIS) was shown to offer advantages in general and oncologic surgery (1). Over the last decade, reduced port laparoscopy (RPL) has been introduced to reduce the risks related to ports and abdominal wall trauma, with enhanced cosmetic outcomes (2). In this video, the authors report the case of a 59-year-old man with a small bowel neuroendocrine tumor, and who underwent a three-trocar right ileocolectomy.
Video: Preoperative work-up, including endoscopic ultrasound, octreoscan, PET-scan, and FDG PET-CT, showed a 15mm small bowel tumor with mesenteric and transverse mesocolic extension, until the muscularis propria of the third portion of the duodenum. The biopsy revealed a low-grade well-differentiated neuroendocrine tumor. The procedure was performed using three abdominal trocars: a 12mm one in the umbilicus, a 5mm one in the right flank, and a 5mm port in the left flank (Figure 1). Abdominal cavity exploration demonstrated the presence of a tumor located in the mesentery of the last small bowel loop, with consequent bowel retraction, dislocation of the caecum and appendix, located under the right lobe of the liver, and tumoral extension into the proximal transverse mesocolon. After mobilization of the right colon from laterally to medially, the second and third duodenal segments were exposed, showing tumor extension towards the anterior duodenal wall of these segments. After encircling the anterior aspect of the duodenal wall with a piece of cotton tape (Figure 2), an endoscopic linear stapler was inserted through the umbilical trocar under the visual guidance of a 5mm scope in the left flank (Figure 3a), and it was fired (Figure 3b). The specimen was removed through a suprapubic access. Perioperative frozen section biopsy showed a free duodenal margin, and the procedure was subsequently completed with an ileocolic anastomosis, performed in a side-to-side handsewn intracorporeal fashion. At the end, the mesocolic defect was closed.

Results: Operative time was 4 hours. No added trocars were necessary. The postoperative course was uneventful and the patient was discharged on postoperative day 4. Pathological findings showed a grade I well-differentiated small bowel neuroendocrine tumor, with lymphovascular emboli and perinervous infiltration (1/20 metastatic nodes, free margins, stage: pT3N1 (8 UICC edition). A follow-up under somatostatin therapy was put forward.

Conclusions: RPL is a feasible option when performing advanced oncological surgery. Patients benefit from all MIS advantages, including reduced trocar complications and enhanced cosmetic outcomes.
G Dapri
Surgical intervention
1 year ago
5852 views
111 likes
0 comments
11:10
Three-trocar laparoscopic right ileocolectomy for advanced small bowel neuroendocrine tumor
Background: Minimally invasive surgery (MIS) was shown to offer advantages in general and oncologic surgery (1). Over the last decade, reduced port laparoscopy (RPL) has been introduced to reduce the risks related to ports and abdominal wall trauma, with enhanced cosmetic outcomes (2). In this video, the authors report the case of a 59-year-old man with a small bowel neuroendocrine tumor, and who underwent a three-trocar right ileocolectomy.
Video: Preoperative work-up, including endoscopic ultrasound, octreoscan, PET-scan, and FDG PET-CT, showed a 15mm small bowel tumor with mesenteric and transverse mesocolic extension, until the muscularis propria of the third portion of the duodenum. The biopsy revealed a low-grade well-differentiated neuroendocrine tumor. The procedure was performed using three abdominal trocars: a 12mm one in the umbilicus, a 5mm one in the right flank, and a 5mm port in the left flank (Figure 1). Abdominal cavity exploration demonstrated the presence of a tumor located in the mesentery of the last small bowel loop, with consequent bowel retraction, dislocation of the caecum and appendix, located under the right lobe of the liver, and tumoral extension into the proximal transverse mesocolon. After mobilization of the right colon from laterally to medially, the second and third duodenal segments were exposed, showing tumor extension towards the anterior duodenal wall of these segments. After encircling the anterior aspect of the duodenal wall with a piece of cotton tape (Figure 2), an endoscopic linear stapler was inserted through the umbilical trocar under the visual guidance of a 5mm scope in the left flank (Figure 3a), and it was fired (Figure 3b). The specimen was removed through a suprapubic access. Perioperative frozen section biopsy showed a free duodenal margin, and the procedure was subsequently completed with an ileocolic anastomosis, performed in a side-to-side handsewn intracorporeal fashion. At the end, the mesocolic defect was closed.

Results: Operative time was 4 hours. No added trocars were necessary. The postoperative course was uneventful and the patient was discharged on postoperative day 4. Pathological findings showed a grade I well-differentiated small bowel neuroendocrine tumor, with lymphovascular emboli and perinervous infiltration (1/20 metastatic nodes, free margins, stage: pT3N1 (8 UICC edition). A follow-up under somatostatin therapy was put forward.

Conclusions: RPL is a feasible option when performing advanced oncological surgery. Patients benefit from all MIS advantages, including reduced trocar complications and enhanced cosmetic outcomes.
Small bowel volvulus over acute bowel invagination: laparoscopic management
Digestive angiodysplasia is a condition defined by an innate alteration of digestive wall vascular structures, which has been well-described since the development of endoscopy. Its cause is not well known and most occurrences are probably innate. Digestive angiodysplasias can be isolated or multiple. They most frequently affect the right colon, and more rarely the stomach, the duodenum and the small bowel. They are the most frequent cause of occult digestive hemorrhage (30 to 40% of cases) and can more rarely cause occlusive episodes through intestinal invagination, linked to a voluminous angiodysplasia lesion.
Here we describe the case of a girl treated for colonic angiodysplasia lesions. She was admitted to our intensive care unit for an occlusive syndrome. CT-scan helped to diagnose a small bowel invagination and decision is made to treat this patient laparoscopically.
More specifically, this 15-year-old girl has a history of strabismus repair in 2011 and right foot surgery for an arteriovenous angiodysplasia lesion. Angiodysplasia was diagnosed after an episode of abdominal pain and a rectorrhagia in 2010. Colonoscopy at this time allowed to find three lesions of 5 to 8mm in diameter. A yearly colonoscopy control is performed. The patient was admitted to the intensive care unit for an occlusive syndrome with abdominal pain. Abdominal ultrasonography suggested an invagination which was confirmed by injected CT-scan. Decision was made to perform a laparoscopic exploration for a disinvagination or a bowel resection.
J Leroy, L Marx, D Mutter, J Marescaux
Surgical intervention
5 years ago
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07:41
Small bowel volvulus over acute bowel invagination: laparoscopic management
Digestive angiodysplasia is a condition defined by an innate alteration of digestive wall vascular structures, which has been well-described since the development of endoscopy. Its cause is not well known and most occurrences are probably innate. Digestive angiodysplasias can be isolated or multiple. They most frequently affect the right colon, and more rarely the stomach, the duodenum and the small bowel. They are the most frequent cause of occult digestive hemorrhage (30 to 40% of cases) and can more rarely cause occlusive episodes through intestinal invagination, linked to a voluminous angiodysplasia lesion.
Here we describe the case of a girl treated for colonic angiodysplasia lesions. She was admitted to our intensive care unit for an occlusive syndrome. CT-scan helped to diagnose a small bowel invagination and decision is made to treat this patient laparoscopically.
More specifically, this 15-year-old girl has a history of strabismus repair in 2011 and right foot surgery for an arteriovenous angiodysplasia lesion. Angiodysplasia was diagnosed after an episode of abdominal pain and a rectorrhagia in 2010. Colonoscopy at this time allowed to find three lesions of 5 to 8mm in diameter. A yearly colonoscopy control is performed. The patient was admitted to the intensive care unit for an occlusive syndrome with abdominal pain. Abdominal ultrasonography suggested an invagination which was confirmed by injected CT-scan. Decision was made to perform a laparoscopic exploration for a disinvagination or a bowel resection.