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Monthly publications

#November 2013
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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.
J Leroy, J Marescaux
Surgical intervention
5 years ago
4011 views
108 likes
0 comments
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 left adrenalectomy for incidentally detected large adrenal mass
We report the typical case of a young woman presenting with an incidentally detected large left adrenal mass. This was a non-functional tumor incidentally detected during ultrasound scan for other reason. CT-scan confirmed a large adrenal mass with diffuse contrast-enhancement. Blood tests for adrenal function were negative.
A laparoscopic left adrenalectomy was proposed with the main objective to perform a complete left adrenalectomy since the malignant nature of the mass cannot be excluded by available imaging studies. For laparoscopic left adrenalectomy, the patient is in a typical right lateral position. The optical trocar is in the left subcostal position. A 10mm trocar is introduced into the anterior axillary line while other 5 or 10mm trocars are placed laterally under the costal margin.
For the surgical resection of this large tumor, dissection started with the opening of the retroperitoneal space, and with the mobilization of the spleen and tail of pancreas. The renal vein is the secondary key point of dissection, allowing to identify the main adrenal vein. At this point, dissection is continued on the right side of the gland in order to identify the left adrenal artery, up to the inferior phrenic vein, and to the superior adrenal artery. The mass is cleared and removed through the extraction bag.
Editorial note: Luigi Mearini et al. have reported a left adrenalectomy exactly reproducing anatomical and technical principles as detailed on WebSurg.com. This confirms that the technique can be reproduced easily.
L Mearini, E Nunzi
Surgical intervention
5 years ago
4633 views
114 likes
0 comments
13:26
Laparoscopic left adrenalectomy for incidentally detected large adrenal mass
We report the typical case of a young woman presenting with an incidentally detected large left adrenal mass. This was a non-functional tumor incidentally detected during ultrasound scan for other reason. CT-scan confirmed a large adrenal mass with diffuse contrast-enhancement. Blood tests for adrenal function were negative.
A laparoscopic left adrenalectomy was proposed with the main objective to perform a complete left adrenalectomy since the malignant nature of the mass cannot be excluded by available imaging studies. For laparoscopic left adrenalectomy, the patient is in a typical right lateral position. The optical trocar is in the left subcostal position. A 10mm trocar is introduced into the anterior axillary line while other 5 or 10mm trocars are placed laterally under the costal margin.
For the surgical resection of this large tumor, dissection started with the opening of the retroperitoneal space, and with the mobilization of the spleen and tail of pancreas. The renal vein is the secondary key point of dissection, allowing to identify the main adrenal vein. At this point, dissection is continued on the right side of the gland in order to identify the left adrenal artery, up to the inferior phrenic vein, and to the superior adrenal artery. The mass is cleared and removed through the extraction bag.
Editorial note: Luigi Mearini et al. have reported a left adrenalectomy exactly reproducing anatomical and technical principles as detailed on WebSurg.com. This confirms that the technique can be reproduced easily.
Laparoscopic gastric pacing
We present the case of a 38-year-old woman with intractable gastroparesis. Her background history was significant for type I diabetes mellitus (DM), a pancreas kidney transplant in 2006, Nissen fundoplication, gastrotomy for bleeding Dieulafoy’s lesion, diabetic retinopathy, peripheral vascular disease, and gastroparesis which was diagnosed in 2007. She complained of daily vomiting, early satiety, abdominal discomfort, nocturnal diarrhea, and significant weight loss. In addition, she had required multiple hospital admissions with severe electrolyte derangement and repeat OGDs. Her symptoms were refractory to motility agents and to Botox therapy. Following a multidisciplinary discussion, she was offered a gastric stimulator. We present a laparoscopic approach to gastric stimulator insertion. The device that we use is the Medtronic Enterra® therapy system. The patient was discharged well after 48 hours. At a follow-up of 4 weeks, her symptoms had improved significantly: her vomiting had reduced to once per week, and she no longer suffered from nocturnal diarrhea. At a follow-up of 3 months, her vomiting had ceased completely and she was gaining weight. The patient returned to work and to normal daily activities.
D Joyce, S Patchett, D Hickey, M Arumugasamy
Surgical intervention
5 years ago
1179 views
33 likes
0 comments
07:01
Laparoscopic gastric pacing
We present the case of a 38-year-old woman with intractable gastroparesis. Her background history was significant for type I diabetes mellitus (DM), a pancreas kidney transplant in 2006, Nissen fundoplication, gastrotomy for bleeding Dieulafoy’s lesion, diabetic retinopathy, peripheral vascular disease, and gastroparesis which was diagnosed in 2007. She complained of daily vomiting, early satiety, abdominal discomfort, nocturnal diarrhea, and significant weight loss. In addition, she had required multiple hospital admissions with severe electrolyte derangement and repeat OGDs. Her symptoms were refractory to motility agents and to Botox therapy. Following a multidisciplinary discussion, she was offered a gastric stimulator. We present a laparoscopic approach to gastric stimulator insertion. The device that we use is the Medtronic Enterra® therapy system. The patient was discharged well after 48 hours. At a follow-up of 4 weeks, her symptoms had improved significantly: her vomiting had reduced to once per week, and she no longer suffered from nocturnal diarrhea. At a follow-up of 3 months, her vomiting had ceased completely and she was gaining weight. The patient returned to work and to normal daily activities.
Reduced port laparoscopic surgery: Roux-en-Y gastric bypass with manual gastrojejunostomy
Background: The philosophy to reduce the invasiveness of minimal access surgery invested the last years of general laparoscopy. Single incision laparoscopic surgery (SILS) has been reported to be feasible and safe. Reduced port laparoscopic surgery (RPLS) consists in performing conventional multiport laparoscopic procedures through a reduction in port number and size. In morbid obesity surgery, since patients undergo plastic reconstruction during follow-up, and the umbilicus is not a landmark and associated with wound complications due to adipose tissue, RPLS appears more valuable than SILS.

Video: A 21-year-old woman was admitted to the centre for morbid obesity. Her preoperative weight was 117 kg and her BMI was 40 kg/m2. A reduced port laparoscopic Roux-en-Y gastric bypass (RPLGB) was proposed. The patient was placed legs apart on the operating table and the surgeon stood between her legs. Three ports were placed: a 12mm port in the umbilicus, a 5mm port in the right flank, and a 5mm port in the left flank. A 10mm, 30-degree scope was introduced into the 12mm port which remained there throughout the procedure except during the insertion of the roticulator linear stapler when the scope was switched to a 5mm, 30-degree one and introduced into the 5mm left flank port. A percutaneous stitch was placed at the apex of the right crus in order to retract the left liver lobe. A conventional Roux-en-Y gastric bypass with manual end-to-side one-layer gastrojejunostomy (length of alimentary limb: 50cm) and linear mechanical side-to-side jejunojejunostomy were performed, including closure of mesenteric and Petersen’s spaces.

Results: Operative time was 120 minutes and blood loss was unsignificant. Postoperative pain was controlled by paracetamol (4 g/day) used during the first 24 hours only. Patient discharge was allowed after 72 hours.

Conclusions: RPLGB for morbid obesity offers favorable cosmetic results in addition to reduced abdominal trauma and postoperative pain.
G Dapri
Surgical intervention
5 years ago
2008 views
14 likes
0 comments
09:19
Reduced port laparoscopic surgery: Roux-en-Y gastric bypass with manual gastrojejunostomy
Background: The philosophy to reduce the invasiveness of minimal access surgery invested the last years of general laparoscopy. Single incision laparoscopic surgery (SILS) has been reported to be feasible and safe. Reduced port laparoscopic surgery (RPLS) consists in performing conventional multiport laparoscopic procedures through a reduction in port number and size. In morbid obesity surgery, since patients undergo plastic reconstruction during follow-up, and the umbilicus is not a landmark and associated with wound complications due to adipose tissue, RPLS appears more valuable than SILS.

Video: A 21-year-old woman was admitted to the centre for morbid obesity. Her preoperative weight was 117 kg and her BMI was 40 kg/m2. A reduced port laparoscopic Roux-en-Y gastric bypass (RPLGB) was proposed. The patient was placed legs apart on the operating table and the surgeon stood between her legs. Three ports were placed: a 12mm port in the umbilicus, a 5mm port in the right flank, and a 5mm port in the left flank. A 10mm, 30-degree scope was introduced into the 12mm port which remained there throughout the procedure except during the insertion of the roticulator linear stapler when the scope was switched to a 5mm, 30-degree one and introduced into the 5mm left flank port. A percutaneous stitch was placed at the apex of the right crus in order to retract the left liver lobe. A conventional Roux-en-Y gastric bypass with manual end-to-side one-layer gastrojejunostomy (length of alimentary limb: 50cm) and linear mechanical side-to-side jejunojejunostomy were performed, including closure of mesenteric and Petersen’s spaces.

Results: Operative time was 120 minutes and blood loss was unsignificant. Postoperative pain was controlled by paracetamol (4 g/day) used during the first 24 hours only. Patient discharge was allowed after 72 hours.

Conclusions: RPLGB for morbid obesity offers favorable cosmetic results in addition to reduced abdominal trauma and postoperative pain.
Laparoscopic enucleation of horseshoe-shaped esophageal leiomyoma: use of mini-instruments
Introduction:
Leiomyoma is the most common benign tumor of the esophagus, usually arising in the inner circular muscle layer of the distal esophagus. Middle-aged men are most frequently affected. Most patients remain asymptomatic and when they become symptomatic, the main signs are usually dysphagia and epigastric pain, but they are not specific to the disease. Malignization is rare but should not be ignored.
The minimally invasive approach to these tumors allows for complete extirpation with minimal morbidity and provides excellent results.

Materials and methods:
We present the case of a 31-year-old woman with no medical history, who underwent a CT-scan for other reasons, namely for urinary symptoms. A 3cm homogeneous, low attenuated mass was found at the gastroesophageal junction. Endoscopic ultrasound is performed and showed a 50mm horseshoe-shaped tumor affecting three quarters of the esophageal circumference. Because of clinical deterioration, and mainly of dysphagia, elective surgery was decided upon.

Results:
In this video, it is possible to appreciate the laparoscopic enucleation of this horseshoe-shaped tumor, which depends on the distal esophageal wall, mainly using blunt dissection. The intervention is completed with a Toupet fundoplication. The postoperative course was uneventful, and the patient is discharged on the third postoperative day, and symptoms are resolved.

Conclusions:
Minimally invasive laparoscopic resection of distal esophageal benign tumors is technically safe and provides the well-known advantages of laparoscopic access, achieving quick patient recovery and a short hospital stay.
Some authors recommend to perform an anti-reflux procedure in order to protect the surgical resection area and therefore prevent complications due to the weakening of the lower esophageal sphincter, such as reflux symptoms.
C Rodríguez-Otero Luppi, EM Targarona Soler, C Balagué Ponz, JL Pallarés Segura, M Trías Folch
Surgical intervention
5 years ago
769 views
4 likes
1 comment
08:45
Laparoscopic enucleation of horseshoe-shaped esophageal leiomyoma: use of mini-instruments
Introduction:
Leiomyoma is the most common benign tumor of the esophagus, usually arising in the inner circular muscle layer of the distal esophagus. Middle-aged men are most frequently affected. Most patients remain asymptomatic and when they become symptomatic, the main signs are usually dysphagia and epigastric pain, but they are not specific to the disease. Malignization is rare but should not be ignored.
The minimally invasive approach to these tumors allows for complete extirpation with minimal morbidity and provides excellent results.

Materials and methods:
We present the case of a 31-year-old woman with no medical history, who underwent a CT-scan for other reasons, namely for urinary symptoms. A 3cm homogeneous, low attenuated mass was found at the gastroesophageal junction. Endoscopic ultrasound is performed and showed a 50mm horseshoe-shaped tumor affecting three quarters of the esophageal circumference. Because of clinical deterioration, and mainly of dysphagia, elective surgery was decided upon.

Results:
In this video, it is possible to appreciate the laparoscopic enucleation of this horseshoe-shaped tumor, which depends on the distal esophageal wall, mainly using blunt dissection. The intervention is completed with a Toupet fundoplication. The postoperative course was uneventful, and the patient is discharged on the third postoperative day, and symptoms are resolved.

Conclusions:
Minimally invasive laparoscopic resection of distal esophageal benign tumors is technically safe and provides the well-known advantages of laparoscopic access, achieving quick patient recovery and a short hospital stay.
Some authors recommend to perform an anti-reflux procedure in order to protect the surgical resection area and therefore prevent complications due to the weakening of the lower esophageal sphincter, such as reflux symptoms.
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.
A D'Urso, J Leroy, T Piardi, P Pessaux, J Marescaux
Surgical intervention
5 years ago
3601 views
54 likes
0 comments
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.
J Leroy, C Saussine, J Marescaux
Surgical intervention
5 years ago
5131 views
108 likes
1 comment
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.
Laparoscopic cholecystectomy in double gallbladder with dual pathology
Surgically significant anatomical variations are commonly encountered in cholecystectomies. Rarer though is double gallbladder. This anomaly adds more complexity to laparoscopy. The author presents a surgical video of laparoscopic cholecystectomy of a symptomatic young man with double gallbladder, highlighting the importance of preoperative diagnosis, meticulous dissection of the cholecysto-hepatic triangle, use of operative cholangiogram, and gentle blunt dissection near the porta hepatis as a recipe of success. Magnetic resonance cholangiopancreatography (MRCP) was suggestive of type 1 V-shaped gallbladder, with a short single cystic duct draining into the CBD. Operative cholangiogram showed one moiety containing the stones communicating with the CBD via a rather long cystic duct, while the other partially intrahepatic moiety was shown to be blind and non-communicating with either the CBD or its counterpart. The second gallbladder was in close proximity to the porta hepatis and to the right hepatic duct. Both gallbladders were supplied by a solitary cystic artery of significant size. Gentle blunt dissection by means of the suction cannula tip helped to dissect the second gallbladder from its intrahepatic position, safeguarding important porta hepatis structures. At the completion of surgery, both gallbladder fossas were carefully inspected to rule out any bile leak. Post-extraction dissection of the specimen showed a calculous cholecystitis in one piece and acalculous pyocele in the other piece, which was confirmed by histopathological examination.
S Ghosh
Surgical intervention
5 years ago
2277 views
16 likes
0 comments
13:23
Laparoscopic cholecystectomy in double gallbladder with dual pathology
Surgically significant anatomical variations are commonly encountered in cholecystectomies. Rarer though is double gallbladder. This anomaly adds more complexity to laparoscopy. The author presents a surgical video of laparoscopic cholecystectomy of a symptomatic young man with double gallbladder, highlighting the importance of preoperative diagnosis, meticulous dissection of the cholecysto-hepatic triangle, use of operative cholangiogram, and gentle blunt dissection near the porta hepatis as a recipe of success. Magnetic resonance cholangiopancreatography (MRCP) was suggestive of type 1 V-shaped gallbladder, with a short single cystic duct draining into the CBD. Operative cholangiogram showed one moiety containing the stones communicating with the CBD via a rather long cystic duct, while the other partially intrahepatic moiety was shown to be blind and non-communicating with either the CBD or its counterpart. The second gallbladder was in close proximity to the porta hepatis and to the right hepatic duct. Both gallbladders were supplied by a solitary cystic artery of significant size. Gentle blunt dissection by means of the suction cannula tip helped to dissect the second gallbladder from its intrahepatic position, safeguarding important porta hepatis structures. At the completion of surgery, both gallbladder fossas were carefully inspected to rule out any bile leak. Post-extraction dissection of the specimen showed a calculous cholecystitis in one piece and acalculous pyocele in the other piece, which was confirmed by histopathological examination.
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.
J Leroy, L Marx, D Mutter, J Marescaux
Surgical intervention
5 years ago
1398 views
19 likes
0 comments
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.
Laparoscopic right ureterovesical reimplantation according to Lich-Gregoir
In 2010, François Varlet from Saint Etienne, France, proposed the laparoscopic extravesical transperitoneal approach according to the Lich-Gregoir technique for the treatment of vesicoureteral reflux in children. If the position of the ureterovesical junction is not ectopic, and by avoiding megaureters, this technique is safe with success rates similar to the open technique. Discussions remain as to a bilateral simultaneous approach, which could lead to bladder dysfunction.
Reference:
Laparoscopic extravesical transperitoneal approach following the Lich-Gregoir technique in the treatment of vesicoureteral reflux in children. Lopez M, Varlet F. J Pediatr Surg 2010;45:806-10.
F Becmeur
Surgical intervention
5 years ago
1097 views
12 likes
0 comments
04:14
Laparoscopic right ureterovesical reimplantation according to Lich-Gregoir
In 2010, François Varlet from Saint Etienne, France, proposed the laparoscopic extravesical transperitoneal approach according to the Lich-Gregoir technique for the treatment of vesicoureteral reflux in children. If the position of the ureterovesical junction is not ectopic, and by avoiding megaureters, this technique is safe with success rates similar to the open technique. Discussions remain as to a bilateral simultaneous approach, which could lead to bladder dysfunction.
Reference:
Laparoscopic extravesical transperitoneal approach following the Lich-Gregoir technique in the treatment of vesicoureteral reflux in children. Lopez M, Varlet F. J Pediatr Surg 2010;45:806-10.
Laparoscopic treatment of a deep endometriotic nodule in the ischiatic tuberosity
In this challenging surgery performed by Professor Arnaud Wattiez, we present the case of a 39-year-old woman suffering from deep infiltrating endometriosis and infertility with no previous surgeries. The patient presented with chronic pelvic pain, dyschezia, and dyspareunia. Preoperative workup included MRI and rectosigmoidoscopy. MRI revealed a nodule at the level of the right uterosacral ligament. Rectosigmoidoscopy revealed a bulging of the anterior rectal wall located at 6cm from the anal verge where biopsy revealed fibrosis. The patient’s physical examination demonstrated the presence of a retrouterine nodule at the site of the right uterosacral ligament measuring 3cm.
A Wattiez, R Fernandes, M Puga, J Alves, C Redondo Guisasola
Surgical intervention
5 years ago
2000 views
35 likes
0 comments
03:00
Laparoscopic treatment of a deep endometriotic nodule in the ischiatic tuberosity
In this challenging surgery performed by Professor Arnaud Wattiez, we present the case of a 39-year-old woman suffering from deep infiltrating endometriosis and infertility with no previous surgeries. The patient presented with chronic pelvic pain, dyschezia, and dyspareunia. Preoperative workup included MRI and rectosigmoidoscopy. MRI revealed a nodule at the level of the right uterosacral ligament. Rectosigmoidoscopy revealed a bulging of the anterior rectal wall located at 6cm from the anal verge where biopsy revealed fibrosis. The patient’s physical examination demonstrated the presence of a retrouterine nodule at the site of the right uterosacral ligament measuring 3cm.
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.
L Marx, F Costantino, J Marescaux
Surgical intervention
5 years ago
5023 views
88 likes
1 comment
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.