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Joël LEROY

Hôpitaux Universitaires de Strasbourg
Strasbourg, Франция
MD, FRCS
26K лайков
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116 комментариев
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Stomal prolapse and parastomal incisional hernia treatment using laparoscopic Sugarbaker modified technique with intraperitoneal onlay mesh repair
Introduction: Prolapse stands for one of the most common complications of colostomy (>10%). Parastomal incisional hernia also represents 10 to 50% of complications. When both are present, the Sugarbaker technique represents a good indication due to mesh repair and pseudo-subperitonization, which can manage both prolapse and hernia. The laparoscopic modified Sugarbaker technique can be performed laparoscopically even in case of multiple previous laparotomies.
Clinical case: We report the case of a 71-year-old male patient presenting with parastomal incisional hernia and stomal prolapse after multiple abdominal procedures for ulcerative colitis, including rectosigmoidectomy, Hartmann procedure for anastomotic leak, left extended colectomy and stomal transposition for ischemic necrosis. An intra-abdominal proctectomy was attempted to manage the recurrence of colitis on the rectal stump. However, this attempt proved unsuccessful, and a local abdominoperineal resection was performed. Due to symptomatic hernia and prolapse, the laparoscopic Sugarbaker modified surgical technique with intraperitoneal onlay mesh (IPOM) repair is performed to manage prolapse by pseudo-subperitonization and to manage hernia using an IPOM repair. As shown in this video, this technique is safe, reproducible, and effective.
Хирургические операции
4 лет назад
2316 просмотров
99 лайков
0 комментариев
10:54
Stomal prolapse and parastomal incisional hernia treatment using laparoscopic Sugarbaker modified technique with intraperitoneal onlay mesh repair
Introduction: Prolapse stands for one of the most common complications of colostomy (>10%). Parastomal incisional hernia also represents 10 to 50% of complications. When both are present, the Sugarbaker technique represents a good indication due to mesh repair and pseudo-subperitonization, which can manage both prolapse and hernia. The laparoscopic modified Sugarbaker technique can be performed laparoscopically even in case of multiple previous laparotomies.
Clinical case: We report the case of a 71-year-old male patient presenting with parastomal incisional hernia and stomal prolapse after multiple abdominal procedures for ulcerative colitis, including rectosigmoidectomy, Hartmann procedure for anastomotic leak, left extended colectomy and stomal transposition for ischemic necrosis. An intra-abdominal proctectomy was attempted to manage the recurrence of colitis on the rectal stump. However, this attempt proved unsuccessful, and a local abdominoperineal resection was performed. Due to symptomatic hernia and prolapse, the laparoscopic Sugarbaker modified surgical technique with intraperitoneal onlay mesh (IPOM) repair is performed to manage prolapse by pseudo-subperitonization and to manage hernia using an IPOM repair. As shown in this video, this technique is safe, reproducible, and effective.
Chronic sigmoidovesical fistula: laparoscopic management
The most frequent underlying cause of sigmoidovesical fistula is complicated diverticular disease in 60% of cases followed by colorectal cancer and inflammatory bowel disease. It occurs in about 2 to 22% of patients with known diverticular disease. In diverticular sigmoid vesical chronic fistula, the preferred therapeutic management is represented by primary resection with anastomosis performed as a one-stage procedure. It is particularly true when the fistula is located between the vesical dome and the sigmoid colon distally from the trigone vesical. In this video, we demonstrate the laparoscopic management of a chronic sigmoidovesical fistula after acute sigmoid diverticulitis as a one-stage procedure.
Хирургические операции
4 лет назад
2024 просмотров
60 лайков
0 комментариев
07:01
Chronic sigmoidovesical fistula: laparoscopic management
The most frequent underlying cause of sigmoidovesical fistula is complicated diverticular disease in 60% of cases followed by colorectal cancer and inflammatory bowel disease. It occurs in about 2 to 22% of patients with known diverticular disease. In diverticular sigmoid vesical chronic fistula, the preferred therapeutic management is represented by primary resection with anastomosis performed as a one-stage procedure. It is particularly true when the fistula is located between the vesical dome and the sigmoid colon distally from the trigone vesical. In this video, we demonstrate the laparoscopic management of a chronic sigmoidovesical fistula after acute sigmoid diverticulitis as a one-stage procedure.
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
4 лет назад
5908 просмотров
174 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 ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.
Хирургические операции
5 лет назад
1909 просмотров
46 лайков
0 комментариев
38:15
Laparoscopic ileocaecal and sigmoid resection with transanal natural orifice specimen extraction (NOSE) for endometriosis
In 12 to 30% of endometriosis cases, the disease is located in the bowel. Caecum and small bowel endometriosis are found in only 3.6% and 7% respectively of those cases while the sigmoid colon and the rectum are most commonly affected in 85% of cases. The laparoscopic management of this disease has evolved drastically over the last decade, and even delicate cases such as small bowel endometriosis can be completely managed by laparoscopy. It is key to be locally invasive towards the disease but conservative with regards to organ function preservation. The specimen will be extracted through natural orifices and without any ileostomy. Our patients are commonly young and healthy women who will certainly benefit from a tailored surgery with immediate symptom relief in addition to minimum abdominal scarring can have a significant positive impact on patient’s psychological well-being and subsequent recovery.
In the present case, we present a 36-year old woman who was diagnosed with endometriosis and presented with 3 episodes of bowel pseudo-obstruction and dyschezia, and put under medical treatment. She was found to have multiple endometriotic nodules, with concurrent ileocaecal and rectosigmoid disease, for which a double bowel resection with transanal natural orifice specimen extraction (NOSE) was performed without complications.
Laparoscopic sigmoidectomy for benign diverticular disease
Dr. Armando Melani beautifully demonstrates a laparoscopic sigmoidectomy technique for a benign diverticular condition. He provides tips and tricks to perfectly expose the operating field and recommends an extensive approach to the left colon with primary mobilization of the splenic flexure using a posterior medial approach with a late vascular approach. The technique and its performance is amply discussed by the panel of experts present, hence providing a very instructive demonstration.
The operator also discusses the different types of energy devices available as well as the tricks to safely perform an upper colorectal anastomosis. This film provides plenty of detailed information for beginners and experts alike to allow them to perform a laparoscopic sigmoidectomy in a perfect fashion.
Хирургические операции
5 лет назад
5982 просмотров
140 лайков
0 комментариев
33:07
Laparoscopic sigmoidectomy for benign diverticular disease
Dr. Armando Melani beautifully demonstrates a laparoscopic sigmoidectomy technique for a benign diverticular condition. He provides tips and tricks to perfectly expose the operating field and recommends an extensive approach to the left colon with primary mobilization of the splenic flexure using a posterior medial approach with a late vascular approach. The technique and its performance is amply discussed by the panel of experts present, hence providing a very instructive demonstration.
The operator also discusses the different types of energy devices available as well as the tricks to safely perform an upper colorectal anastomosis. This film provides plenty of detailed information for beginners and experts alike to allow them to perform a laparoscopic sigmoidectomy in a perfect fashion.
Laparoscopic oncologic right colectomy for cancer in an obese patient: interest of a full laparoscopic procedure with ileocolic “in“ anastomosis
In this video, the author demonstrates the possibilities of an laparoscopic oncologic approach to perform a right colectomy in an obese patient.
After a primary vascular approach, the colon is freed from its posterior and lateral attachments prior to being resected. The intracorporeal anastomosis is beautifully described and substantiated here.
Finally, the author underlines the benefit of using dissection instruments recently developed by the medical device Industry (Sonicision™, V-Loc™, and Tri-Staple™ Technology by Covidien).
Хирургические операции
5 лет назад
10254 просмотров
341 лайков
0 комментариев
29:10
Laparoscopic oncologic right colectomy for cancer in an obese patient: interest of a full laparoscopic procedure with ileocolic “in“ anastomosis
In this video, the author demonstrates the possibilities of an laparoscopic oncologic approach to perform a right colectomy in an obese patient.
After a primary vascular approach, the colon is freed from its posterior and lateral attachments prior to being resected. The intracorporeal anastomosis is beautifully described and substantiated here.
Finally, the author underlines the benefit of using dissection instruments recently developed by the medical device Industry (Sonicision™, V-Loc™, and Tri-Staple™ Technology by Covidien).
Colonic stomal prolapse and parastomal incisional hernia: laparoscopic Sugarbaker repair procedure
The objective of this film is to demonstrate stoma prolapse and parastomal incisional hernia repair according to the technique described by Sugarbaker in open surgery, reproduced here with a laparoscopic approach.
Mesh placement into the abdominal cavity presents a risk that seems minimized by the development of dual-sided composite meshes, with one collagen coating that will be in contact with the digestive tract, hence limiting the risk of adhesions.
The principle of the Sugarbaker technique is to create a colonic zigzag route and to fix it on the non-absorbable side of the mesh, thereby preventing colonic prolapse. The mesh is also used as an obstacle to the passage of small bowel loops into the parastomal defect.
Here, the difficulty lies in the combined presence of an incisional hernia and prolapse on a diverting transverse colostomy. The risk of vascular injury is all the more important. Here, authors highlight pitfalls as well as tips and tricks to overcome them.
Хирургические операции
5 лет назад
4157 просмотров
108 лайков
0 комментариев
11:09
Colonic stomal prolapse and parastomal incisional hernia: laparoscopic Sugarbaker repair procedure
The objective of this film is to demonstrate stoma prolapse and parastomal incisional hernia repair according to the technique described by Sugarbaker in open surgery, reproduced here with a laparoscopic approach.
Mesh placement into the abdominal cavity presents a risk that seems minimized by the development of dual-sided composite meshes, with one collagen coating that will be in contact with the digestive tract, hence limiting the risk of adhesions.
The principle of the Sugarbaker technique is to create a colonic zigzag route and to fix it on the non-absorbable side of the mesh, thereby preventing colonic prolapse. The mesh is also used as an obstacle to the passage of small bowel loops into the parastomal defect.
Here, the difficulty lies in the combined presence of an incisional hernia and prolapse on a diverting transverse colostomy. The risk of vascular injury is all the more important. Here, authors highlight pitfalls as well as tips and tricks to overcome them.
Laparoscopic sigmoidectomy for sigmoiditis with transanal specimen extraction
The objective of this video is to demonstrate a sigmoid colectomy technique for a diverticular sigmoiditis with a transanal extraction of the resected colonic segment. The goal of this video is to demonstrate the feasibility of this technique by means of only 3 trocars to further reduce parietal damage. The author reveals his tips and tricks for a perfectly standardized minimally invasive operative technique. In addition to colonic extraction, the different stages of mechanical anastomosis are perfectly outlined. This team recommends that this type of intervention should be used for benign pathologies.
Хирургические операции
5 лет назад
2399 просмотров
51 лайков
0 комментариев
21:57
Laparoscopic sigmoidectomy for sigmoiditis with transanal specimen extraction
The objective of this video is to demonstrate a sigmoid colectomy technique for a diverticular sigmoiditis with a transanal extraction of the resected colonic segment. The goal of this video is to demonstrate the feasibility of this technique by means of only 3 trocars to further reduce parietal damage. The author reveals his tips and tricks for a perfectly standardized minimally invasive operative technique. In addition to colonic extraction, the different stages of mechanical anastomosis are perfectly outlined. This team recommends that this type of intervention should be used for benign pathologies.
Incisional hernia: laparoscopic hybrid repair
About 10% of laparotomies are complicated by the development of incisional hernia (1). The prosthetic repair is the rule in the treatment of incisional hernia and is reported to have a lower recurrence rate than primary suture repair (2). The laparoscopic approach proposed since the early nineties with intraperitoneal onlay mesh (IPOM) repair has gained popularity over years. The IPOM technique is easy in case of midline incisional hernia but is more complex in case of lateral suprailiac hernia. The laparoscopic repair is associated with fewer infections as compared to the open technique (3). There are only very few reports on laparoscopic-endoscopic sublay mesh repair of abdominal wall hernias (4, 5).
We present the case of a 66-year-old patient admitted for an incisional hernia subsequent to an open liver resection for gallbladder carcinoma in 2011. The patient developed a symptomatic lateral incisional hernia in the right side of his subcostal incision. The oncologic preoperative work-up was negative. The patient was scheduled for a laparoscopic approach with a hybrid onlay and sublay mesh repair.
Here, authors aim to propose an original technique with a combined onlay and sublay approach to this complicated lateral abdominal incisional hernia.
Bibliographic references:
1. Mudge M, Hughes LE. Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 1985;72:70-1.
2. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004;240:578-83.
3. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 2011;3:CD007781.
4. Schroeder AD, Debus ES, Schroeder M, Reinpold WM. Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc. 2013;27:648-54.
5. Miserez M, Penninckx F. Endoscopic totally preperitoneal ventral hernia repair. Surg Endosc 2002;16:1207-13.
Хирургические операции
5 лет назад
3778 просмотров
56 лайков
0 комментариев
07:27
Incisional hernia: laparoscopic hybrid repair
About 10% of laparotomies are complicated by the development of incisional hernia (1). The prosthetic repair is the rule in the treatment of incisional hernia and is reported to have a lower recurrence rate than primary suture repair (2). The laparoscopic approach proposed since the early nineties with intraperitoneal onlay mesh (IPOM) repair has gained popularity over years. The IPOM technique is easy in case of midline incisional hernia but is more complex in case of lateral suprailiac hernia. The laparoscopic repair is associated with fewer infections as compared to the open technique (3). There are only very few reports on laparoscopic-endoscopic sublay mesh repair of abdominal wall hernias (4, 5).
We present the case of a 66-year-old patient admitted for an incisional hernia subsequent to an open liver resection for gallbladder carcinoma in 2011. The patient developed a symptomatic lateral incisional hernia in the right side of his subcostal incision. The oncologic preoperative work-up was negative. The patient was scheduled for a laparoscopic approach with a hybrid onlay and sublay mesh repair.
Here, authors aim to propose an original technique with a combined onlay and sublay approach to this complicated lateral abdominal incisional hernia.
Bibliographic references:
1. Mudge M, Hughes LE. Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 1985;72:70-1.
2. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004;240:578-83.
3. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 2011;3:CD007781.
4. Schroeder AD, Debus ES, Schroeder M, Reinpold WM. Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc. 2013;27:648-54.
5. Miserez M, Penninckx F. Endoscopic totally preperitoneal ventral hernia repair. Surg Endosc 2002;16:1207-13.
TAPP laparoscopic repair of right inguinal hernia after artificial sphincter placement for post-prostatectomy urinary incontinence
Incapacitating post-prostatectomy urinary incontinence may be managed by the placement of an artificial sphincter. This sphincter is composed of an inflatable circular tape (the sphincter itself), a remote control located in the scrotum, and of a reservoir connected to the sphincter by a catheter. This reservoir is positioned within the preperitoneal space using an anterior inguinal approach through a mini-incision in the transversalis fascia which weakens the posterior wall of the inguinal canal, hence increasing the risk of inguinal hernia.
This film demonstrates a typical case management of such hernia. The anterior approach is delicate as repair of the inguinal canal may well induce trauma to the catheter connected to the retromuscular balloon. The posterior approach is therefore valuable as it allows to see the balloon prior to dissecting the preperitoneal space. The film highlights the specific issues to be dealt with as well as the tips and tricks related to this approach.
Хирургические операции
5 лет назад
5260 просмотров
108 лайков
0 комментариев
08:18
TAPP laparoscopic repair of right inguinal hernia after artificial sphincter placement for post-prostatectomy urinary incontinence
Incapacitating post-prostatectomy urinary incontinence may be managed by the placement of an artificial sphincter. This sphincter is composed of an inflatable circular tape (the sphincter itself), a remote control located in the scrotum, and of a reservoir connected to the sphincter by a catheter. This reservoir is positioned within the preperitoneal space using an anterior inguinal approach through a mini-incision in the transversalis fascia which weakens the posterior wall of the inguinal canal, hence increasing the risk of inguinal hernia.
This film demonstrates a typical case management of such hernia. The anterior approach is delicate as repair of the inguinal canal may well induce trauma to the catheter connected to the retromuscular balloon. The posterior approach is therefore valuable as it allows to see the balloon prior to dissecting the preperitoneal space. The film highlights the specific issues to be dealt with as well as the tips and tricks related to this approach.