Ghassan SOJOD

This is the case of a patient admitted to hospital for a sensation of lump in the left hypochondrium, which has been progressing for one week. The patient also reported a left hypochondrium pain. On clinical exam, a left hypochondrium sensitivity was observed and there was no sign of peritoneal irritation. An abdominopelvic CT-scan showed a voluminous splenic cyst of congenital origin (either an epidermoid cyst or a mesothelial cyst). Laparoscopic splenectomy is performed under general anesthesia. Pathological findings showed the presence of a multilocular epithelial cyst.

The surgical treatment of large umbilical hernias includes a parietal reinforcement by means of a synthetic prosthesis. The laparoscopic approach with double mesh placement has proven to provide several benefits over the open approach. Here, we present the case of a patient presenting with a painful irreducible umbilical hernia. The video demonstrates the placement of an intraperitoneal prosthesis as well as an original herniorrhaphy technique using a non-absorbable suture.

In this video, authors show a full laparoscopic small bowel resection with intracorporeal anastomosis and mesenteric lymphadenectomy for multiple neuroendocrine tumors and laparoscopic liver ultrasonography for suspicion of liver metastases.

The objective of this film is to demonstrate a fully laparoscopic original technique for the restoration of the ileorectal continuity after total colectomy for colonic obstruction in a pT4aN0M0 advanced colonic cancer which was operated on 10 months earlier (Hartmann procedure) and then managed by chemotherapy.

Laparoscopic Roux-en-Y gastric bypass (LGBP) has been shown to be an effective treatment for morbid obesity, both in terms of weight loss and improvement in multiple comorbidities. While the laparoscopic approach offers many advantages to patients in terms of fewer wound complications, decreased length of hospital stay, and decreased postoperative pain, some complications of this operation continue to pose difficult clinical problems as the number of procedures performed increases. One such complication is internal hernia through one of the mesenteric defects, which can result in small bowel obstruction (SBO), ischemia, or infarction, and often requires emergency reoperation.
Internal hernias is a significant clinical problem, since it is the most common cause of small bowel obstruction after LGBP. Retrospective reviews have found the incidence of SBO after LGBP to be between 1.8 and 9.7%. The creation of a potential space as a result of weight loss may also be a contributing factor in the etiology of internal hernias, which often present in a delayed fashion. In addition, the particular case of pregnancy (with the mass effect of an enlarging uterus) may predispose to this condition.
An internal hernia can potentially occur through either two or three defects, depending on whether a retrocolic or antecolic technique is used for the Roux limb. Petersen’s defect is defined as the space between the Roux limb and the transverse mesocolon. A defect is also present between the biliopancreatic and Roux limbs at the jejunojejunostomy. If a retrocolic approach is used, a third defect in the transverse mesocolon is created. This is the most common site of internal hernia in most reports, which has prompted many surgeons to adopt an antecolic technique in order to rule out this defect.

Roux-en-Y gastric bypass is a common procedure in bariatric surgery. It can be perfectly standardized in order to make it technically easier to perform and to reduce risks of postoperative complications. This video shows a conventional gastric bypass procedure with linear gastrojejunostomy. The intervention ran smoothly. Twenty-four hours postoperatively, the patient complained of abdominal pain. Serum chemistries demonstrated severe inflammatory signs. An emergency CT-scan demonstrated a gastrojejunal fistula. It was decided to perform an emergency laparoscopic reintervention. An anastomotic dehiscence was identified and sutured. The postoperative outcome was finally uneventful.