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Ludovic MARX

Hôpitaux Universitaires de Strasbourg
Strasbourg, Франция
MD
2.6K лайка
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Large intradiverticulum endoscopic biliary sphincterotomy
Periampullary duodenal diverticula are observed in 10-20% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and could well increase ampulla cannulation failure risk, as well as potential complications related to endoscopic sphincterotomy.
Here we report two successful cases of large intradiverticular endoscopic biliary sphincterotomy in the treatment of two different kinds of benign biliary pathologies. The first case was that of a woman with multiple large stones in the common bile duct (CBD). The second case was one of a male patient with cholestasis due to a compression of the distal common bile duct caused by a diverticulum – this condition being known as Lemmel’s syndrome.
Хирургические операции
2 года назад
1366 просмотров
77 лайков
0 комментариев
05:09
Large intradiverticulum endoscopic biliary sphincterotomy
Periampullary duodenal diverticula are observed in 10-20% of patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and could well increase ampulla cannulation failure risk, as well as potential complications related to endoscopic sphincterotomy.
Here we report two successful cases of large intradiverticular endoscopic biliary sphincterotomy in the treatment of two different kinds of benign biliary pathologies. The first case was that of a woman with multiple large stones in the common bile duct (CBD). The second case was one of a male patient with cholestasis due to a compression of the distal common bile duct caused by a diverticulum – this condition being known as Lemmel’s syndrome.
Laparoscopic Roux-en-Y gastric bypass redo after sleeve gastrectomy associated with intrathoracic sleeve migration
Sleeve gastrectomy is a standard procedure in bariatric surgery nowadays. However, common contraindications involve the presence of gastroesophageal reflux and hiatal hernia. Here, we present the case of a morbidly obese female patient with a past surgical history of a Nissen fundoplication reversed in 2012 because of dysphagia. A sleeve gastrectomy had been performed 2 years ago complicated by an intrathoracic migration and gastric twist as discovered in the preoperative control followed by dysphagia, reflux, and vomiting. A conversion to a Roux-en-Y gastric bypass has been decided upon.
Хирургические операции
4 года назад
1667 просмотров
47 лайков
1 комментарий
09:21
Laparoscopic Roux-en-Y gastric bypass redo after sleeve gastrectomy associated with intrathoracic sleeve migration
Sleeve gastrectomy is a standard procedure in bariatric surgery nowadays. However, common contraindications involve the presence of gastroesophageal reflux and hiatal hernia. Here, we present the case of a morbidly obese female patient with a past surgical history of a Nissen fundoplication reversed in 2012 because of dysphagia. A sleeve gastrectomy had been performed 2 years ago complicated by an intrathoracic migration and gastric twist as discovered in the preoperative control followed by dysphagia, reflux, and vomiting. A conversion to a Roux-en-Y gastric bypass has been decided upon.
Laparoscopic transcystic and hybrid transgastric rendezvous technique for common bile duct lithiasis after gastric bypass
Common bile duct lithiasis has become a challenging problem in patients who have undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity. Altered anatomy due to gastric diversion and biliary limb reconstruction leads to a prolonged and complex access to the ampulla of Vater. Consequently, experienced endoscopists and double-balloon endoscopes are required, often making it impossible to successfully perform an endoscopic sphincterotomy as in this case.
Here, we describe the case of a patient who had already been operated on for a gastric bypass and who presented with multiple past episodes of cholangitis because of common bile duct stones. A double-balloon endoscopic sphincterotomy failed leading to the decision of surgical treatment combining a hybrid technique of laparoscopic transgastric sphincterotomy with a transcystic common bile duct exploration.
Хирургические операции
4 года назад
1173 просмотра
45 лайков
0 комментариев
11:34
Laparoscopic transcystic and hybrid transgastric rendezvous technique for common bile duct lithiasis after gastric bypass
Common bile duct lithiasis has become a challenging problem in patients who have undergone a laparoscopic Roux-en-Y gastric bypass for morbid obesity. Altered anatomy due to gastric diversion and biliary limb reconstruction leads to a prolonged and complex access to the ampulla of Vater. Consequently, experienced endoscopists and double-balloon endoscopes are required, often making it impossible to successfully perform an endoscopic sphincterotomy as in this case.
Here, we describe the case of a patient who had already been operated on for a gastric bypass and who presented with multiple past episodes of cholangitis because of common bile duct stones. A double-balloon endoscopic sphincterotomy failed leading to the decision of surgical treatment combining a hybrid technique of laparoscopic transgastric sphincterotomy with a transcystic common bile duct exploration.
Collis Nissen procedure after lung transplantation and laparoscopic management of mediastinal hematoma
After lung transplantation, GERD causes inflammatory reactions, increasing risks for obliterating bronchiolitis and dysfunctioning graft. Authors first present a laparoscopic Collis Nissen procedure for hiatal hernia and severe esophagitis in a grafted patient. Because of a short esophagus despite extended dissection, a Collis gastroplasty is required. After stapling, cruroplasty is performed, finally followed by a Nissen fundoplication. In case of severe esophagitis, a difficult dissection and inflammatory tissues can lead to more complications such as leak, hemorrhage, slippage, and abscess. Mediastinal hematoma is diagnosed on postoperative day 9, mandating a redo emergency intervention. This rare complication will be managed laparoscopically.
Хирургические операции
5 лет назад
1744 просмотра
58 лайков
0 комментариев
21:07
Collis Nissen procedure after lung transplantation and laparoscopic management of mediastinal hematoma
After lung transplantation, GERD causes inflammatory reactions, increasing risks for obliterating bronchiolitis and dysfunctioning graft. Authors first present a laparoscopic Collis Nissen procedure for hiatal hernia and severe esophagitis in a grafted patient. Because of a short esophagus despite extended dissection, a Collis gastroplasty is required. After stapling, cruroplasty is performed, finally followed by a Nissen fundoplication. In case of severe esophagitis, a difficult dissection and inflammatory tissues can lead to more complications such as leak, hemorrhage, slippage, and abscess. Mediastinal hematoma is diagnosed on postoperative day 9, mandating a redo emergency intervention. This rare complication will be managed laparoscopically.
Laparoscopic management of a type III Mirizzi syndrome: cholecystectomy with flag technique and ideal suture of a cholecystobiliary fistula
In this video, authors demonstrate the laparoscopic management of a Mirizzi syndrome. Due to a cholecystocholedochal fistula and to a difficult dissection of Calot’s triangle, authors decided to modify the dissection technique by performing a primary freeing of the gallblader as described by Jean Mouiel. In order to prevent any further biliary damage, a subtotal cholecystectomy is also achieved by means of an EndoGia™ linear stapler. Cholecystobiliary fistula is repaired using an absorbable running suture protected by an internal choledochal drain placed thanks to preoperative endoscopic catheterization.
Хирургические операции
5 лет назад
6008 просмотров
176 лайков
0 комментариев
07:11
Laparoscopic management of a type III Mirizzi syndrome: cholecystectomy with flag technique and ideal suture of a cholecystobiliary fistula
In this video, authors demonstrate the laparoscopic management of a Mirizzi syndrome. Due to a cholecystocholedochal fistula and to a difficult dissection of Calot’s triangle, authors decided to modify the dissection technique by performing a primary freeing of the gallblader as described by Jean Mouiel. In order to prevent any further biliary damage, a subtotal cholecystectomy is also achieved by means of an EndoGia™ linear stapler. Cholecystobiliary fistula is repaired using an absorbable running suture protected by an internal choledochal drain placed thanks to preoperative endoscopic catheterization.
Laparoscopic Roux-en-Y gastric bypass: second redo
Bariatric surgery has undergone a rapid evolution over the last few years. Nowadays, laparoscopic sleeve gastrectomy represents a valuable alternative to laparoscopic Roux-en-Y gastric bypass, especially in patients with a very high BMI and in whom a gastric bypass procedure may be difficult. A thorough preoperative evaluation should always be performed in order to rule out any contraindication (e.g., hiatal hernia, gastroesophageal reflux). Here, we present a case of a female patient suffering from severe gastroesophageal reflux after sleeve gastrectomy associated with a major weight regain further to two bariatric surgeries.
Хирургические операции
5 лет назад
2302 просмотра
18 лайков
0 комментариев
10:17
Laparoscopic Roux-en-Y gastric bypass: second redo
Bariatric surgery has undergone a rapid evolution over the last few years. Nowadays, laparoscopic sleeve gastrectomy represents a valuable alternative to laparoscopic Roux-en-Y gastric bypass, especially in patients with a very high BMI and in whom a gastric bypass procedure may be difficult. A thorough preoperative evaluation should always be performed in order to rule out any contraindication (e.g., hiatal hernia, gastroesophageal reflux). Here, we present a case of a female patient suffering from severe gastroesophageal reflux after sleeve gastrectomy associated with a major weight regain further to two bariatric surgeries.
Laparoscopic and endoscopic treatment of a complicated candy cane syndrome after Roux-en-Y gastric bypass
A “Candy Cane” Roux syndrome represents an excessive length of non-functional Roux limb proximal to the gastrojejunostomy, which can cause abnormal upper gastrointestinal symptoms of postprandial epigastric discomfort that is relieved by vomiting. Symptoms of reflux, loss of satiety, and nausea are also common. The length of the blind loop is the essential factor to explain these symptoms, but the orientation of the gastrojejunal anastomosis is equally important to facilitate the emptying of the gastric pouch.
Scarce data can be found in the literature --a case report (1) and a case series (2) with a number of limitations. It is not possible to determine a critical excess length of Roux limb at which symptoms would become evident, nor were we able to determine whether all patients, or just a small minority, would develop symptoms, even with a seemingly excessive Roux limb.
Patients who underwent a gastric bypass technique with a gastrojejunal anastomosis using a circular stapler seem to be more likely to develop this anomaly. All 3 patients described by Cottam et al. (2) have their primary procedure performed by means of a circular stapler.
A long, non-functional Roux limb tip may cause persistent nausea, postprandial epigastric pain, and even a lack of satiety. Surgeons should attempt to minimize redundancy in the Roux limb during the primary procedure. Limiting the length and orientating the Roux limb to aid in gravity and drainage during the initial operation may prevent this syndrome.
References:
1. Dallal RM, Cottam D. "Candy cane" Roux syndrome--a possible complication after gastric bypass surgery. Surg Obes Relat Dis 2007;3:408-10.
2. Romero-Mejía C, Camacho-Aguilera JF, Paipilla-Monroy O. "Candy cane" Roux syndrome in laparoscopic gastric by-pass. Cir Cir 2010;78:347-51.
Хирургические операции
5 лет назад
1520 просмотров
10 лайков
0 комментариев
05:57
Laparoscopic and endoscopic treatment of a complicated candy cane syndrome after Roux-en-Y gastric bypass
A “Candy Cane” Roux syndrome represents an excessive length of non-functional Roux limb proximal to the gastrojejunostomy, which can cause abnormal upper gastrointestinal symptoms of postprandial epigastric discomfort that is relieved by vomiting. Symptoms of reflux, loss of satiety, and nausea are also common. The length of the blind loop is the essential factor to explain these symptoms, but the orientation of the gastrojejunal anastomosis is equally important to facilitate the emptying of the gastric pouch.
Scarce data can be found in the literature --a case report (1) and a case series (2) with a number of limitations. It is not possible to determine a critical excess length of Roux limb at which symptoms would become evident, nor were we able to determine whether all patients, or just a small minority, would develop symptoms, even with a seemingly excessive Roux limb.
Patients who underwent a gastric bypass technique with a gastrojejunal anastomosis using a circular stapler seem to be more likely to develop this anomaly. All 3 patients described by Cottam et al. (2) have their primary procedure performed by means of a circular stapler.
A long, non-functional Roux limb tip may cause persistent nausea, postprandial epigastric pain, and even a lack of satiety. Surgeons should attempt to minimize redundancy in the Roux limb during the primary procedure. Limiting the length and orientating the Roux limb to aid in gravity and drainage during the initial operation may prevent this syndrome.
References:
1. Dallal RM, Cottam D. "Candy cane" Roux syndrome--a possible complication after gastric bypass surgery. Surg Obes Relat Dis 2007;3:408-10.
2. Romero-Mejía C, Camacho-Aguilera JF, Paipilla-Monroy O. "Candy cane" Roux syndrome in laparoscopic gastric by-pass. Cir Cir 2010;78:347-51.
Robot-assisted gastric band removal: any limitations?
Nowadays, indications for gastric band removal are well-standardized. In case of esophageal or gastric dilatation, migration or any injury related to the LAP-BAND® access port or tubing, the band and its access port should be removed. In rare specific cases, part of the LAP-BAND® system (either access port or band) may be preserved.
Before proceeding to the surgical band removal, a complete preoperative radiological and endoscopic work-up should be performed.
Here, we present the case of a 62-year-old woman who benefited from gastric band placement 10 years earlier. The band proved effective. However, for several weeks, she has been suffering from abdominal pain associated with vomiting and hematemesis.
After a work-up which included CT-scanning, water-soluble contrast swallow and gastroscopy, it was decided to remove the band.
Хирургические операции
5 лет назад
775 просмотров
11 лайков
0 комментариев
08:36
Robot-assisted gastric band removal: any limitations?
Nowadays, indications for gastric band removal are well-standardized. In case of esophageal or gastric dilatation, migration or any injury related to the LAP-BAND® access port or tubing, the band and its access port should be removed. In rare specific cases, part of the LAP-BAND® system (either access port or band) may be preserved.
Before proceeding to the surgical band removal, a complete preoperative radiological and endoscopic work-up should be performed.
Here, we present the case of a 62-year-old woman who benefited from gastric band placement 10 years earlier. The band proved effective. However, for several weeks, she has been suffering from abdominal pain associated with vomiting and hematemesis.
After a work-up which included CT-scanning, water-soluble contrast swallow and gastroscopy, it was decided to remove the band.
Laparoscopic internal hernia repair after mini gastric bypass
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.
Хирургические операции
6 лет назад
1598 просмотров
18 лайков
0 комментариев
05:08
Laparoscopic internal hernia repair after mini gastric bypass
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.
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.
Хирургические операции
6 лет назад
1454 просмотра
19 лайков
0 комментариев
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.
Right hemicolectomy for appendicular mucocele
The appendicular mucocele is defined by a dilation of the appendix and an unusual accumulation of mucus within its lumen. It is a rare pathology which affects 0.25% of the population.
Its histological discovery is made during the postoperative phase in nearly 70% of cases. Appendicular mucoceles, which are secondary to a muco-secretive tumor, can potentially be a problem if they are malignant, especially in case of preoperative or intraoperative rupture, with a risk of gelatinous disease of the peritoneum.
The positive diagnosis is based on a histological study, which must be systematic, for all appendectomy specimens. Preoperatively, it is essential to recognize an appendicular mucocele, in order to properly adapt the surgical technique, and to potentially envisage a more global surgical resection technique.
We present the case of a 70-year-old man, treated in our unit for right iliac fossa abscess in which an explorative laparoscopy was decided upon after one month of medical treatment.
Хирургические операции
6 лет назад
5438 просмотров
89 лайков
0 комментариев
07:16
Right hemicolectomy for appendicular mucocele
The appendicular mucocele is defined by a dilation of the appendix and an unusual accumulation of mucus within its lumen. It is a rare pathology which affects 0.25% of the population.
Its histological discovery is made during the postoperative phase in nearly 70% of cases. Appendicular mucoceles, which are secondary to a muco-secretive tumor, can potentially be a problem if they are malignant, especially in case of preoperative or intraoperative rupture, with a risk of gelatinous disease of the peritoneum.
The positive diagnosis is based on a histological study, which must be systematic, for all appendectomy specimens. Preoperatively, it is essential to recognize an appendicular mucocele, in order to properly adapt the surgical technique, and to potentially envisage a more global surgical resection technique.
We present the case of a 70-year-old man, treated in our unit for right iliac fossa abscess in which an explorative laparoscopy was decided upon after one month of medical treatment.
Tips 'n tricks: cholecystectomy: antegrade approach for difficult dissection
Today, laparoscopic cholecystectomy is a routinely performed surgical intervention. In certain cases, the identification of Calot’s triangle may be difficult due to adhesions or inflammatory infiltrations of adjacent structures. Hydrodissection can allow for an atraumatic dissection but in more complex cases, an antegrade freeing of the gallbladder should be envisaged.
Here we present the case of a man benefiting from a difficult laparoscopic cholecystectomy for a pancreatitis with common bile duct stone migration. The flag technique, with an antegrade freeing, must be applied in order to complete the procedure laparoscopically.
Хирургические операции
6 лет назад
4960 просмотров
77 лайков
0 комментариев
06:50
Tips 'n tricks: cholecystectomy: antegrade approach for difficult dissection
Today, laparoscopic cholecystectomy is a routinely performed surgical intervention. In certain cases, the identification of Calot’s triangle may be difficult due to adhesions or inflammatory infiltrations of adjacent structures. Hydrodissection can allow for an atraumatic dissection but in more complex cases, an antegrade freeing of the gallbladder should be envisaged.
Here we present the case of a man benefiting from a difficult laparoscopic cholecystectomy for a pancreatitis with common bile duct stone migration. The flag technique, with an antegrade freeing, must be applied in order to complete the procedure laparoscopically.
Occurrence of a rare complication during laparoscopic sleeve gastrectomy
Nowadays, sleeve gastrectomy is a common procedure frequently performed laparoscopically in the management of morbid obesity. This intervention as proven to be efficient in comparison to laparoscopic Roux-en-Y gastric bypass (LRYGB) regarding weight loss and revision of obesity-related co-morbidities such as diabetes mellitus and high blood pressure. Today, in France, selection of the surgical technique (e.g., sleeve gastrectomy, LRYGB) depends on the patient should preoperative work-up be strictly normal. If not, the surgeon will have to make a decision as to which technique should be used. Postoperative complications related to bariatric surgery are currently well-known (fistula, bleeding, abscess) and are managed in a multidisciplinary way by radiologists, endoscopists and surgeons. Here, we present the case of a rare perioperative complication related to the incidental stapling of the nasogastric tube during gastric division. This complication mainly highlights shortcomings in the interaction between the surgical team and anesthesiologists during placement and retrieval of calibration and nasogastric tubes. In the present case, this complication was immediately demonstrated and it was managed laparoscopically.
Хирургические операции
6 лет назад
2958 просмотров
26 лайков
0 комментариев
08:29
Occurrence of a rare complication during laparoscopic sleeve gastrectomy
Nowadays, sleeve gastrectomy is a common procedure frequently performed laparoscopically in the management of morbid obesity. This intervention as proven to be efficient in comparison to laparoscopic Roux-en-Y gastric bypass (LRYGB) regarding weight loss and revision of obesity-related co-morbidities such as diabetes mellitus and high blood pressure. Today, in France, selection of the surgical technique (e.g., sleeve gastrectomy, LRYGB) depends on the patient should preoperative work-up be strictly normal. If not, the surgeon will have to make a decision as to which technique should be used. Postoperative complications related to bariatric surgery are currently well-known (fistula, bleeding, abscess) and are managed in a multidisciplinary way by radiologists, endoscopists and surgeons. Here, we present the case of a rare perioperative complication related to the incidental stapling of the nasogastric tube during gastric division. This complication mainly highlights shortcomings in the interaction between the surgical team and anesthesiologists during placement and retrieval of calibration and nasogastric tubes. In the present case, this complication was immediately demonstrated and it was managed laparoscopically.
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.
Хирургические операции
6 лет назад
1843 просмотра
12 лайков
0 комментариев
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.
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.
Хирургические операции
6 лет назад
3001 просмотр
20 лайков
0 комментариев
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.
Laparoscopic cholecystectomy 2 months after acute cholecystitis with intra-abdominal abscess
Cholecystectomy for symptomatic gallstones is mainly performed as soon as an acute cholecystitis episode settles. The main reason is the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis.
Acute cholecystitis is generally caused by gallstones. Gallstones affect about 10% of the population in the Western world but over 80% of people with gallstones are asymptomatic. Acute cholecystitis develops in 1 to 3% of patients with symptomatic gallstones. Cholecystectomy can be performed by laparotomy or by laparoscopy, either at the time of the initial attack (early treatment) or 2 to 3 months after the initial attack has subsided (delayed treatment). A factor complicating the assessment of outcomes of early treatment is that “early” has been variably defined as anywhere from 24 hours to 5 days after either the onset of symptoms or the time of diagnosis. If a delayed or conservative treatment is selected, patients are treated during the acute phase with antibiotics, very occasionally patients undergo percutaneous cholecystostomy (placement of a tube in the gallbladder). Fifteen to 20% of patients who underwent delayed procedures had persistent or recurrent symptoms requiring intervention before the planned operation. Today early laparoscopic cholecystectomy is considered to be the treatment of choice for most patients.
Хирургические операции
6 лет назад
8330 просмотров
119 лайков
1 комментарий
07:53
Laparoscopic cholecystectomy 2 months after acute cholecystitis with intra-abdominal abscess
Cholecystectomy for symptomatic gallstones is mainly performed as soon as an acute cholecystitis episode settles. The main reason is the fear of higher morbidity and conversion from laparoscopic cholecystectomy to open cholecystectomy during acute cholecystitis.
Acute cholecystitis is generally caused by gallstones. Gallstones affect about 10% of the population in the Western world but over 80% of people with gallstones are asymptomatic. Acute cholecystitis develops in 1 to 3% of patients with symptomatic gallstones. Cholecystectomy can be performed by laparotomy or by laparoscopy, either at the time of the initial attack (early treatment) or 2 to 3 months after the initial attack has subsided (delayed treatment). A factor complicating the assessment of outcomes of early treatment is that “early” has been variably defined as anywhere from 24 hours to 5 days after either the onset of symptoms or the time of diagnosis. If a delayed or conservative treatment is selected, patients are treated during the acute phase with antibiotics, very occasionally patients undergo percutaneous cholecystostomy (placement of a tube in the gallbladder). Fifteen to 20% of patients who underwent delayed procedures had persistent or recurrent symptoms requiring intervention before the planned operation. Today early laparoscopic cholecystectomy is considered to be the treatment of choice for most patients.
Gastric mucosal laceration managed with endoscopic clipping during ESD in a patient with Child Class A liver cirrhosis
Patients with liver cirrhosis present with portal hypertension (PHT), which causes various pathological changes in the entire gastrointestinal tract (from esophagus to anus). In this video, the Mallory Weiss tear (MWT) occurred accidentally during ESD of a gastric antral adenoma in a cirrhotic patient. It was successfully managed by means of endoscopic clipping. The patient had two episodes of retching during endoscopy, which might have contributed to gastric over-distension. With esophagogastroduodenoscopy (EGD) being so commonly performed in cirrhotic patients and ESD being more and more commonly used for treatment of gastric mucosal lesions, this case report should serve as a precautionary reminder in such case scenarios.
Хирургические операции
7 лет назад
773 просмотра
11 лайков
0 комментариев
02:57
Gastric mucosal laceration managed with endoscopic clipping during ESD in a patient with Child Class A liver cirrhosis
Patients with liver cirrhosis present with portal hypertension (PHT), which causes various pathological changes in the entire gastrointestinal tract (from esophagus to anus). In this video, the Mallory Weiss tear (MWT) occurred accidentally during ESD of a gastric antral adenoma in a cirrhotic patient. It was successfully managed by means of endoscopic clipping. The patient had two episodes of retching during endoscopy, which might have contributed to gastric over-distension. With esophagogastroduodenoscopy (EGD) being so commonly performed in cirrhotic patients and ESD being more and more commonly used for treatment of gastric mucosal lesions, this case report should serve as a precautionary reminder in such case scenarios.
Emergency endoscopic esophageal variceal band ligation for active bleeding
Upper digestive bleeding is a frequent complication in cirrhotic patients. In some cases, it can be disastrous with collapse, especially considering coagulopathies in these patients. The management must be multidisciplinary involving an anesthesiologist, an endoscopist, and sometimes an interventional radiologist.
Emergency variceal band ligation is the first step to achieve hemostasis once the patient has been medically stabilized.
This video presents the case of a 91-year-old cirrhotic man, presenting with hepatitis C virus (HCV). He was admitted to the emergency department for massive hematemesis. Blood tests showed hemoglobin levels at 8 g/dL and the patient was hemodynamically stable. Sandostatin® injection, proton pump inhibitors (PPI), antibiotics, vitamin K were started immediately to a full dose regimen. Once fresh frozen plasma and blood transfusion have been carried out, an endoscopy was scheduled within the first 12 hours.
Хирургические операции
7 лет назад
1625 просмотров
26 лайков
0 комментариев
02:05
Emergency endoscopic esophageal variceal band ligation for active bleeding
Upper digestive bleeding is a frequent complication in cirrhotic patients. In some cases, it can be disastrous with collapse, especially considering coagulopathies in these patients. The management must be multidisciplinary involving an anesthesiologist, an endoscopist, and sometimes an interventional radiologist.
Emergency variceal band ligation is the first step to achieve hemostasis once the patient has been medically stabilized.
This video presents the case of a 91-year-old cirrhotic man, presenting with hepatitis C virus (HCV). He was admitted to the emergency department for massive hematemesis. Blood tests showed hemoglobin levels at 8 g/dL and the patient was hemodynamically stable. Sandostatin® injection, proton pump inhibitors (PPI), antibiotics, vitamin K were started immediately to a full dose regimen. Once fresh frozen plasma and blood transfusion have been carried out, an endoscopy was scheduled within the first 12 hours.
Single stage laparo-endoscopic management of acute cholecystitis and common bile duct stones
This video demonstrates the case of a 27-year-old woman, admitted to the emergency department for acute right hypochondrium pain.
Clinical examination found a positive Murphy’s sign. Biological findings showed a cholestasis (Gamma Glutamyl Transferase at 576 l/U, Alkaline Phosphatase at 346 l/U), and cytolysis (AST at 460 I/U, ALT at 635 I/U) without jaundice.
Abdominal ultrasonography confirmed the presence of acute cholecystitis with thickening of the gallbladder wall associated with a moderate 8mm dilatation of the common bile duct without any lithiasis.
Antibiotic therapy was started and cholecystectomy with intraoperative cholangiography was decided upon because of the clinical presentation and biological disturbance.
Хирургические операции
7 лет назад
2017 просмотров
10 лайков
0 комментариев
04:38
Single stage laparo-endoscopic management of acute cholecystitis and common bile duct stones
This video demonstrates the case of a 27-year-old woman, admitted to the emergency department for acute right hypochondrium pain.
Clinical examination found a positive Murphy’s sign. Biological findings showed a cholestasis (Gamma Glutamyl Transferase at 576 l/U, Alkaline Phosphatase at 346 l/U), and cytolysis (AST at 460 I/U, ALT at 635 I/U) without jaundice.
Abdominal ultrasonography confirmed the presence of acute cholecystitis with thickening of the gallbladder wall associated with a moderate 8mm dilatation of the common bile duct without any lithiasis.
Antibiotic therapy was started and cholecystectomy with intraoperative cholangiography was decided upon because of the clinical presentation and biological disturbance.
Loop-and-let-go technique for symptomatic descending colonic lipoma
Large symptomatic colonic lipomas require treatment, but resection of lipomas by means of endoscopic cautery snare carries some risk of colonic perforation. The loop-and-let-go technique described here is technically simple; anyone who is well acquainted with the snare cautery technique can do it. It looks safer than the conventionally employed snare cautery technique, as no current is used with the loop-and-let-go technique. It causes selective occlusive ischemia of mucosa and submucosa without causing any transmural damage. The total duration needed for the lipoma to slough off depends on the quality of endoloop occlusion and the type of lipoma (narrow-based vs wide-based).
Хирургические операции
7 лет назад
897 просмотров
3 лайка
0 комментариев
02:16
Loop-and-let-go technique for symptomatic descending colonic lipoma
Large symptomatic colonic lipomas require treatment, but resection of lipomas by means of endoscopic cautery snare carries some risk of colonic perforation. The loop-and-let-go technique described here is technically simple; anyone who is well acquainted with the snare cautery technique can do it. It looks safer than the conventionally employed snare cautery technique, as no current is used with the loop-and-let-go technique. It causes selective occlusive ischemia of mucosa and submucosa without causing any transmural damage. The total duration needed for the lipoma to slough off depends on the quality of endoloop occlusion and the type of lipoma (narrow-based vs wide-based).
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.
Хирургические операции
7 лет назад
3236 просмотров
63 лайка
0 комментариев
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.
Endoscopic management of cystic duct leakage after cholecystectomy
Biliary leaks still represent a significant problem following open or laparoscopic cholecystectomy. The incidence of bile duct leaks after such operations was reported to range between 0.3 and 1%. This video presents the case of a 75-year-old man who was referred to our department for fever, jaundice, and abdominal pain 12 days after laparoscopic cholecystectomy. A cholangio-MRI was carried out. It demonstrated an intra-abdominal biliary collection at the level of the gallbladder bed. A leak from the cystic duct was suspected. A radiological drainage of the collection was performed, and an endoscopic sphincterotomy with plastic stenting of the common bile duct was achieved. The patient went clinically well and at 2 months, the stent was removed. Two months after stent removal, he is totally symptom-free.
Хирургические операции
7 лет назад
1897 просмотров
4 лайка
0 комментариев
02:55
Endoscopic management of cystic duct leakage after cholecystectomy
Biliary leaks still represent a significant problem following open or laparoscopic cholecystectomy. The incidence of bile duct leaks after such operations was reported to range between 0.3 and 1%. This video presents the case of a 75-year-old man who was referred to our department for fever, jaundice, and abdominal pain 12 days after laparoscopic cholecystectomy. A cholangio-MRI was carried out. It demonstrated an intra-abdominal biliary collection at the level of the gallbladder bed. A leak from the cystic duct was suspected. A radiological drainage of the collection was performed, and an endoscopic sphincterotomy with plastic stenting of the common bile duct was achieved. The patient went clinically well and at 2 months, the stent was removed. Two months after stent removal, he is totally symptom-free.
Endoscopic intragastric balloon as a bridge to bariatric surgery for the management of a superobese patient
The use of an air-filled intragastric balloon is effective in achieving a relevant loss of body weight. It is used as a bridge to definitive surgery in superobese patients for whom surgery is often associated with high risks. The balloon helps reduce the volume of the stomach and leads to a premature feeling of satiety. These endoscopic bariatric bridging procedures can reduce the overall risk related to the surgical intervention, as measured by the use of the American Society of Anesthesiologists Physical Status Classification System, and promote cardiopulmonary and metabolic improvement. By reducing truncal/visceral obesity, these endoscopic bariatric procedures can ease off technical difficulties related to subsequent surgical interventions.
In this video, we show the case of a 44-year-old superobese man with a BMI of 63, presenting with diabetes mellitus and obstructive sleep apnea, in which a Heliosphere® BAG Pre OP balloon was positioned with the objective of weight reduction.
The procedure is performed under general anesthesia with orotracheal intubation, and with the patient in supine position. Upper endoscopy did not show any lesions or any contraindications to the gastric balloon implantation.
All the procedure is carried out under endoscopic control. In retroversion, good positioning of the inflated balloon is controlled at the level of the fundus floating freely.
PPI drugs are administered throughout the procedure.
The patient is discharged on postoperative day one after starting a liquid diet, and on the following day, he is on a normal hypocaloric diet.
The patient is scheduled to have the Heliosphere® BAG Pre OP removed within six months.
Хирургические операции
8 лет назад
1306 просмотров
9 лайков
0 комментариев
02:14
Endoscopic intragastric balloon as a bridge to bariatric surgery for the management of a superobese patient
The use of an air-filled intragastric balloon is effective in achieving a relevant loss of body weight. It is used as a bridge to definitive surgery in superobese patients for whom surgery is often associated with high risks. The balloon helps reduce the volume of the stomach and leads to a premature feeling of satiety. These endoscopic bariatric bridging procedures can reduce the overall risk related to the surgical intervention, as measured by the use of the American Society of Anesthesiologists Physical Status Classification System, and promote cardiopulmonary and metabolic improvement. By reducing truncal/visceral obesity, these endoscopic bariatric procedures can ease off technical difficulties related to subsequent surgical interventions.
In this video, we show the case of a 44-year-old superobese man with a BMI of 63, presenting with diabetes mellitus and obstructive sleep apnea, in which a Heliosphere® BAG Pre OP balloon was positioned with the objective of weight reduction.
The procedure is performed under general anesthesia with orotracheal intubation, and with the patient in supine position. Upper endoscopy did not show any lesions or any contraindications to the gastric balloon implantation.
All the procedure is carried out under endoscopic control. In retroversion, good positioning of the inflated balloon is controlled at the level of the fundus floating freely.
PPI drugs are administered throughout the procedure.
The patient is discharged on postoperative day one after starting a liquid diet, and on the following day, he is on a normal hypocaloric diet.
The patient is scheduled to have the Heliosphere® BAG Pre OP removed within six months.