We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.

Monthly publications

#April 2013
Filter by
Specialty

Type
Category
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.
L Marx, J Leroy, J Marescaux
Surgical intervention
5 years ago
2945 views
20 likes
0 comments
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 stepwise approach of a tumor of the gastroesophageal junction
GISTs are rare neoplasms that account for less than 1% of all gastrointestinal malignancies. GISTs have the capability to become malignant and then metastasize, whereas leiomyomas are almost invariably benign. In clinical practice, preoperative differentiation between GISTs and leiomyomas is usually difficult, even if EUS-guided fine-needle aspiration or trucut biopsy is performed. Leiomyomas are rare in the stomach and duodenum while GIST are more frequent in the stomach.
This patient presented with a 6cm submucosal tumor below the gastroesophageal junction. This video demonstrates the stepwise laparoscopic approach taking into consideration the potentially (pre-)malignant nature of the tumor.
B Dallemagne, S Perretta, S Mandala, J Marescaux
Surgical intervention
5 years ago
1732 views
17 likes
0 comments
26:11
Laparoscopic stepwise approach of a tumor of the gastroesophageal junction
GISTs are rare neoplasms that account for less than 1% of all gastrointestinal malignancies. GISTs have the capability to become malignant and then metastasize, whereas leiomyomas are almost invariably benign. In clinical practice, preoperative differentiation between GISTs and leiomyomas is usually difficult, even if EUS-guided fine-needle aspiration or trucut biopsy is performed. Leiomyomas are rare in the stomach and duodenum while GIST are more frequent in the stomach.
This patient presented with a 6cm submucosal tumor below the gastroesophageal junction. This video demonstrates the stepwise laparoscopic approach taking into consideration the potentially (pre-)malignant nature of the tumor.
Laparoscopic revision of stenotic colorectal anastomosis
Background: Colorectal anastomosis is usually performed using a circular stapler inserted transanally. Postoperative complications such as strictures are rare and related to various factors like ischemia, poor vascularization, and previous leak. This video shows a laparoscopic revision of a stenotic colorectal anastomosis, solved with a new hand-sewn anastomosis.

Video: A 51-year-old man underwent laparoscopic sigmoidectomy for symptomatic diverticulosis. At that time, a transanal circular mechanical end-to-end colorectal anastomosis was performed using a 29mm circular stapler. After 3 months of follow-up, a symptomatic stenotic colorectal anastomosis was evidenced, and endoscopic dilatation (repeated 3 times) remained unsuccessful. Preoperative barium enema showed a stenotic anastomosis and some residual diverticulosis. A laparoscopic 3-trocar revision was scheduled. On exploration of the abdominal cavity, the anastomosis appeared thickened and strictly adherent to the left ureter. After proper mobilization, a segmental colorectal resection was performed and a new anastomosis was fashioned in an end-to-end hand-sewn technique.

Results: The procedure was completed by laparoscopy without additional trocars. Operative time was 202 minutes and blood loss 20cc. The patient was allowed to be discharged on the 4th postoperative day, and after 6 months, he is fine, without intestinal trouble.

Conclusions: Postoperative complications of colorectal anastomosis, such as strictures, can be managed laparoscopically. A new hand-sewn anastomosis is feasible and it allows for control of the vascularization and openings of both colonic and rectal lumens.
G Dapri
Surgical intervention
5 years ago
1896 views
20 likes
0 comments
06:20
Laparoscopic revision of stenotic colorectal anastomosis
Background: Colorectal anastomosis is usually performed using a circular stapler inserted transanally. Postoperative complications such as strictures are rare and related to various factors like ischemia, poor vascularization, and previous leak. This video shows a laparoscopic revision of a stenotic colorectal anastomosis, solved with a new hand-sewn anastomosis.

Video: A 51-year-old man underwent laparoscopic sigmoidectomy for symptomatic diverticulosis. At that time, a transanal circular mechanical end-to-end colorectal anastomosis was performed using a 29mm circular stapler. After 3 months of follow-up, a symptomatic stenotic colorectal anastomosis was evidenced, and endoscopic dilatation (repeated 3 times) remained unsuccessful. Preoperative barium enema showed a stenotic anastomosis and some residual diverticulosis. A laparoscopic 3-trocar revision was scheduled. On exploration of the abdominal cavity, the anastomosis appeared thickened and strictly adherent to the left ureter. After proper mobilization, a segmental colorectal resection was performed and a new anastomosis was fashioned in an end-to-end hand-sewn technique.

Results: The procedure was completed by laparoscopy without additional trocars. Operative time was 202 minutes and blood loss 20cc. The patient was allowed to be discharged on the 4th postoperative day, and after 6 months, he is fine, without intestinal trouble.

Conclusions: Postoperative complications of colorectal anastomosis, such as strictures, can be managed laparoscopically. A new hand-sewn anastomosis is feasible and it allows for control of the vascularization and openings of both colonic and rectal lumens.
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.
C Mathoulin
Surgical intervention
5 years ago
466 views
6 likes
0 comments
06:26
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.