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Université virtuelle

La plus grande bibliothèque en ligne de vidéos en chirurgie mini-invasive.

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Le site WebSurg est l’université en ligne de l’IRCAD, créée pour les chirurgiens par des chirurgiens, accessible à tous et entièrement gratuite. Il offre un contenu spécialisé en chirurgie mini-invasive, classé selon différentes spécialités et technologies de pointe : chirurgie générale et digestive, urologie, gynécologie, chirurgie pédiatrique, chirurgie endoscopique, chirurgie de la base crânienne, arthroscopie et chirurgie des membres supérieurs, etc. Définissez vos objectifs professionnels et regardez les vidéos correspondant aux spécialités qui vous intéressent.

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Vidéo chirurgicale
09:56
Winslow's hiatal hernia: laparoscopic treatment
Less than 200 cases of internal hernia have been described through the hiatus of Winslow, usually related to congenital or acquired anatomical defects. The most frequent affectation corresponds to the colon, small intestine and, rarely, to the gallbladder. There is usually occlusion with variable grade ischemia, but it can also occur as obstructive jaundice, biliary colic, secondary pancreatitis and non-symptomatic herniation.
The association of Winslow’s hiatus hernia with various anatomical abnormalities (high or subhepatic caecum, mobile ascending colon, large and long colonic mesentery, etc.) may actually correspond to different degrees of intestinal malrotation and, although the diagnosis of “malrotation” is not usually specified, we believe that this could underlie part of Winslow’s hiatus hernia associated with non-acquired anatomical defects.
Hiatal hernia corresponds to 0.2-0.9% of all cases of intestinal obstruction, of which 8% are from Winslow’s hiatus. If pre-surgical diagnosis is difficult, it occurs in less than 10% of cases.
Mortality is around 50% when it has vascular implication. We have not thought of applying the omentum to seal the defect because we did not have adequate surgical anchor sites since we were working millimeters from the vena cava, extrahepatic bile duct, duodenum, and perirenal area. We decided to fix the colon from the hepatic flexure to the right iliac fossa with continuous stitches, from the colonic serosa to Toldt’s fascia, as it is from the embryonic stage.
Winslow's hiatal hernia: laparoscopic treatment
JL Limon Aguilar, CO Castillo Cabrera
52 vues
Il y a 1 jour
Vidéo chirurgicale
11:43
Proximal gastrectomy with stapled circular esophagogastrostomy: manual purse-string technique
Early tumors of the esophagogastric junction can be managed with a minimally invasive proximal gastrectomy. This operation has recently been reevaluated for early-stage tumors since it offers a good postoperative quality of life with oncological outcomes equivalent to more extended procedures. In this video, we present the case of a 72-year-old man presenting with a 2cm adenocarcinoma of the esophagogastric junction. The clinical stage of the lesion was T1N0. A laparoscopic proximal gastrectomy with stapled circular esophagogastrostomy was decided upon. Five ports were placed. The left trocar incision was enlarged to introduce the circular stapler for the anastomoses and for specimen extraction. The procedure began with a complete abdominal exploration to rule out peritoneal metastases. The gastrocolic and gastrosplenic ligaments were divided with an ultrasonic scalpel. Short splenic vessels were clipped and divided and the greater curvature completely isolated with careful preservation of the gastroepiploic arcade and of the right gastroepiploic artery and vein. Left gastric vessels were divided at their origin with a vascular stapler and the distal esophagus was isolated through the diaphragmatic hiatus. A gastric tube was created with multiple applications of a linear stapler. The anvil of the circular stapler was secured to the esophageal stump with a hand-sewn purse-string suture in order to avoid the overlap of two suture lines. The esophagogastric anastomosis was then achieved with a circular stapler.
Proximal gastrectomy with stapled circular esophagogastrostomy: manual purse-string technique
C Battiston, D Citterio, L Conti, M Virdis, V Mazzaferro
35 vues
Il y a 1 jour
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