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Monthly publications

#May 2012
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Laparoscopic repair of giant type 4 paraesophageal hernia
Type 4 giant hiatal hernias are not common. The stomach is herniated, as well as viscera in the mediastinum, colon, spleen, and even sometimes in the pancreas. Repair is challenging for different reasons. This type of hernia is frequent in older and fragile patients. Reduction of the sac from the mediastinum is mandatory and must be carried out following stepwise and precise dissection rules: it has to be done outside of the sac, in an anatomical cleavage plane. Crural repair is challenging and must be tailored on the quality of the diaphragmatic musculature and size of the orifice. Anti-reflux repair must be performed as well. The laparoscopic approach has radically improved the clinical outcome of this procedure in old patients.
B Dallemagne, E Marzano, S Perretta, J Marescaux
Surgical intervention
6 years ago
4664 views
78 likes
0 comments
21:43
Laparoscopic repair of giant type 4 paraesophageal hernia
Type 4 giant hiatal hernias are not common. The stomach is herniated, as well as viscera in the mediastinum, colon, spleen, and even sometimes in the pancreas. Repair is challenging for different reasons. This type of hernia is frequent in older and fragile patients. Reduction of the sac from the mediastinum is mandatory and must be carried out following stepwise and precise dissection rules: it has to be done outside of the sac, in an anatomical cleavage plane. Crural repair is challenging and must be tailored on the quality of the diaphragmatic musculature and size of the orifice. Anti-reflux repair must be performed as well. The laparoscopic approach has radically improved the clinical outcome of this procedure in old patients.
Single stage laparoscopic management of common bile duct stones with acute cholecystitis
Ten to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP), open surgery, or laparoscopic surgery.
The first option depends mainly on the availability of an experienced endocopist who could successfully clear stones in most patients. However no stones are found in 20% to 60% of cases. In such patients, rare and unpredictably severe ERCP morbidity can occur.
Thanks to progress in laparosocopic techniques, associated with technological developments, the single stage laparoscopic management of CBD and gallbladder stones has become one of the main options for the treatement of choledocholithiasis associated with cholelithiasis.
After the analysis of local conditions and the interpretation of intraoperative cholangiography images it is fundamental to decide which type of access to use to get to the main biliary tract, either transcystic access or directly through choledochotomy.
J D'Agostino, J Marescaux
Surgical intervention
6 years ago
6346 views
64 likes
2 comments
06:11
Single stage laparoscopic management of common bile duct stones with acute cholecystitis
Ten to 18% of patients undergoing cholecystectomy for gallstones have common bile duct (CBD) stones. Treatment options for these stones include pre- or post-operative endoscopic retrograde cholangiopancreatography (ERCP), open surgery, or laparoscopic surgery.
The first option depends mainly on the availability of an experienced endocopist who could successfully clear stones in most patients. However no stones are found in 20% to 60% of cases. In such patients, rare and unpredictably severe ERCP morbidity can occur.
Thanks to progress in laparosocopic techniques, associated with technological developments, the single stage laparoscopic management of CBD and gallbladder stones has become one of the main options for the treatement of choledocholithiasis associated with cholelithiasis.
After the analysis of local conditions and the interpretation of intraoperative cholangiography images it is fundamental to decide which type of access to use to get to the main biliary tract, either transcystic access or directly through choledochotomy.
Laparoscopic oophoropexy
This is the case of a 25-year-old woman with a previous history of right ovarian torsion that necessitates removal of that ovary. The patient expressed concern regarding fertility and possible torsion of the left ovary in the future.
During laparoscopy, an elongated utero-ovarian ligament was noticed. Decision was made to proceed with oophoropexy to decrease the chance of ovarian torsion in the future.
The video demonstrates the back load technique of the needle introduced through the 5mm port incision to achieve optimal cosmetic results.
The needle was passed through the left utero-ovarian ligament. Plication started from the ovarian end towards the uterine end. Extracorporeal knot was tied.
Interceed™ was used to minimize the risk of subsequent adhesions.
M Milad, N Latif, I Moy
Surgical intervention
6 years ago
7583 views
204 likes
0 comments
03:05
Laparoscopic oophoropexy
This is the case of a 25-year-old woman with a previous history of right ovarian torsion that necessitates removal of that ovary. The patient expressed concern regarding fertility and possible torsion of the left ovary in the future.
During laparoscopy, an elongated utero-ovarian ligament was noticed. Decision was made to proceed with oophoropexy to decrease the chance of ovarian torsion in the future.
The video demonstrates the back load technique of the needle introduced through the 5mm port incision to achieve optimal cosmetic results.
The needle was passed through the left utero-ovarian ligament. Plication started from the ovarian end towards the uterine end. Extracorporeal knot was tied.
Interceed™ was used to minimize the risk of subsequent adhesions.