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El-Magd ESA, Elgeidie A, Abbas A, Elmahdy Y, LotfyAbulazm I, Hamed H. Laparoscopic approach in the management of diaphragmatic eventration in adults: gastrointestinal surgical perspective. Updates Surg 2024; 76:555-563. [PMID: 37847484 PMCID: PMC10995002 DOI: 10.1007/s13304-023-01665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
The current literature is poor with studies handling the role of laparoscopy in managing diaphragmatic eventration (DE). Herein, we describe our experience regarding the role of laparoscopy in managing DE patients presenting mainly with gastrointestinal symptoms. We retrospectively reviewed the data of 20 patients who underwent laparoscopic diaphragmatic plication between January 2010 and December 2018. Postoperative outcomes and quality of life were assessed. Most DEs were left sided (95%). Laparoscopic diaphragmatic plication was possible in all patients, along with correcting all associated gastrointestinal and diaphragmatic problems. The former included gastric volvulus (60%), reflux esophagitis (25%), cholelithiasis (5%), and pyloric obstruction (5%), while the latter included diaphragmatic and hiatus hernia (10% and 15%, respectively).The average operative time was 142 min. All patients had a regular (reviewer #1) postoperative course except for one who developed hydro-pneumothorax. At a median follow-up of 48 months, midterm outcomes were satisfactory, with an improvement (reviewer #1) in gastrointestinal symptoms. Three patients (reviewer #1) developed radiological recurrence without significant clinical symptoms. Patient's quality of life, including all parameters, significantly improved after the laparoscopic procedure compared to the preoperative values. Laparoscopic approach is safe and effective for managing adult diaphragmatic eventration (reviewer #1).
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Affiliation(s)
- El-Sayed Abou El-Magd
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt.
| | - Ahmed Elgeidie
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
| | - Amr Abbas
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
| | - Youssif Elmahdy
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
| | - Ibrahem LotfyAbulazm
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
| | - Hosam Hamed
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia, Egypt
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Shadmanov N, Aliyev V, Piozzi GN, Bakır B, Goksel S, Asoglu O. Perioperative and long-term oncological outcomes of robotic versus laparoscopic total mesorectal excision: a retrospective study of 672 patients. J Robot Surg 2024; 18:144. [PMID: 38554211 DOI: 10.1007/s11701-024-01922-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/01/2024]
Abstract
Although there's growing information about the long-term oncological effects of robotic surgery for rectal cancer, the procedure is still relatively new. This study aimed to assess the long-term oncological results of total mesorectal excision (TME) performed laparoscopically versus robotically in the setting of rectal cancer. Restrospective analysis of a prospectively maintained database. A total of 489 laparoscopic (L-TME) and 183 robotic total mesorectal excisions (R-TME) were carried out by a single surgeon between 2013 and 2023. The groups were compared in terms of perioperative and long-term oncological outcomes. In the R-TME and L-TME groups, male sex predominated (75.4% and 57.3%, respectively), although the robotic group was significantly greater (p = 0.008). There was no conversion in R-TME group, whereas three (0.6%) converted to open surgery in L-TME group. The R-TME group had a statistically significant higher number of distal rectal tumors (85%) compared to the L-TME group (54.6%). Only three (1.7%) patients in the R-TME group received abdomineperineal resection (APR); in contrast, 25 (5%) patients in the L-TME group received APR (p < 0.001). For R-TME, the mean follow-up was 70.7 months (range 18-138) and for L-TME, it was 60 months (range 14-140). Frequency of completed mesorectum was significantly greater in R-TME group (98.9% vs 94.2%, p < 0.001). The 5 year overall survival rates for R-TME and L-TME groups were 89.6% and 88.7%, respectively. The 5 year disease-free survival for R-TME and L-TME groups were 84.1% and 81.1%, respectively. The local recurrences rates were 7.6% and 6.3%, respectively in R-TME and L-TME groups (p = 0.274). R-TME is characterized by no conversion and improved mesorectal integrity. R-TME had longer operation time. The long-term oncological outcomes were comparable between groups.
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Affiliation(s)
| | - Vusal Aliyev
- Bogazici Academy for Clinical Sciences, Istanbul, Turkey
- Department of General Surgery, Bagcılar Medilife Hospital, Istanbul, Turkey
| | | | - Barıs Bakır
- Department of Radiology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Suha Goksel
- Department of Pathology, Maslak Acibadem Hospital, Istanbul, Turkey
| | - Oktar Asoglu
- Bogazici Academy for Clinical Sciences, Istanbul, Turkey.
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Hinojosa-Ramirez F, Tallon-Aguilar L, Tinoco-Gonzalez J, Sanchez-Arteaga A, Aguilar-Del Castillo F, Alarcon-Del Agua I, Morales-Conde S. Economic analysis of the robotic approach to inguinal hernia versus laparoscopic: is it sustainable for the healthcare system? Hernia 2024:10.1007/s10029-024-03006-y. [PMID: 38503978 DOI: 10.1007/s10029-024-03006-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION There has been a rapid proliferation of the robotic approach to inguinal hernia, mainly in the United States, as it has shown similar outcomes to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in our setting (Spanish National Health System). MATERIALS AND METHODS A retrospective single-center comparative study on inguinal hernia repair using a robotic approach versus laparoscopic approach. RESULTS A total of 98 patients who underwent either robotic or laparoscopic TAPP inguinal hernia repair between October 2021 and July 2023 were analyzed. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p < 0.001), an extended hospital stays (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p < 0.007), as well as higher procedural costs (2318.63 ± 205.15 € vs. 356.81 ± 110.14 €, p < 0.001) and total hospitalization costs (3272.48 ± 408.49 € vs. 1048.61 ± 460.06 €, p < 0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias. CONCLUSIONS The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.
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Affiliation(s)
- F Hinojosa-Ramirez
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - L Tallon-Aguilar
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain.
- Surgery Department, University of Seville, Avda. Doctor Fedriani, s/n, 41009, Seville, Spain.
| | - J Tinoco-Gonzalez
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
- Surgery Department, University of Seville, Avda. Doctor Fedriani, s/n, 41009, Seville, Spain
| | - A Sanchez-Arteaga
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - F Aguilar-Del Castillo
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - I Alarcon-Del Agua
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
| | - S Morales-Conde
- Department of Surgery, Hospital Universitario Virgen del Rocío, Av Manuel Siurot S/N, 41013, Seville, Spain
- Surgery Department, University of Seville, Avda. Doctor Fedriani, s/n, 41009, Seville, Spain
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Che Ghazali K, Yaacob H, Mohamed Sidek AS. Combined laparoscopic and endoscopic method for foreign body removal from descending colon: A case report. World J Surg Proced 2024; 14:1-7. [DOI: 10.5412/wjsp.v14.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/23/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND The majority of published reports on foreign bodies (FBs) involve the rectum and applied a transanal retrieval. Usually, patients with FB above the rectum are subjected to laparotomy for removal. Here, we illustrate the case of a man with an FB that had migrated into the descending colon, and its successful removal via a laparoscopic approach.
CASE SUMMARY A 43-year-old man, who had the habit of FB insertion into his anus to aid defecation, presented upon experience of such an FB slipping through and migrating upward to the distal colon. Plain abdominal radiograph revealed a bottle-shaped FB, positioned in the left iliac fossa region. The FB was successfully removed via a laparoscopic-assisted procedure in which we combined diagnostic laparoscopic and endoscopic techniques during surgery. The patient was monitored for 2 d postoperatively and subsequently discharged home.
CONCLUSION A minimally invasive approach should be adopted to aid extraction of colorectal FB as it is effective and safe.
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Affiliation(s)
| | - Huzairi Yaacob
- Department of Surgery, Hospital Raja Perempuan Zainab II, Kota Bharu 15586, Malaysia
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Sermonesi G, Tian BWCA, Vallicelli C, Abu-Zidan FM, Damaskos D, Kelly MD, Leppäniemi A, Galante JM, Tan E, Kirkpatrick AW, Khokha V, Romeo OM, Chirica M, Pikoulis M, Litvin A, Shelat VG, Sakakushev B, Wani I, Sall I, Fugazzola P, Cicuttin E, Toro A, Amico F, Mas FD, De Simone B, Sugrue M, Bonavina L, Campanelli G, Carcoforo P, Cobianchi L, Coccolini F, Chiarugi M, Di Carlo I, Di Saverio S, Podda M, Pisano M, Sartelli M, Testini M, Fette A, Rizoli S, Picetti E, Weber D, Latifi R, Kluger Y, Balogh ZJ, Biffl W, Jeekel H, Civil I, Hecker A, Ansaloni L, Bravi F, Agnoletti V, Beka SG, Moore EE, Catena F. Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma. World J Emerg Surg 2023; 18:57. [PMID: 38066631 PMCID: PMC10704840 DOI: 10.1186/s13017-023-00520-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma. METHODS This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement. RESULTS A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma. CONCLUSIONS The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.
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Affiliation(s)
- Giacomo Sermonesi
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Brian W C A Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Carlo Vallicelli
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | | | - Ari Leppäniemi
- Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Oreste Marco Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Mircea Chirica
- Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - Manos Pikoulis
- 3Rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, Gomel, Belarus
| | | | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ibrahima Sall
- General Surgery Department, Military Teaching Hospital, Dakar, Senegal
| | - Paola Fugazzola
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Enrico Cicuttin
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Francesco Amico
- Discipline of Surgery, School of Medicine and Public Health, Newcastle, Australia
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Campus Economico San Giobbe Cannaregio, 873, 30100, Venice, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Luigi Bonavina
- Department of Surgery, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | - Paolo Carcoforo
- Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy
| | - Lorenzo Cobianchi
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salomone Di Saverio
- General Surgery Department Hospital of San Benedetto del Tronto, Marche Region, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andreas Fette
- Pediatric Surgery, Children's Care Center, SRH Klinikum Suhl, Suhl, Thuringia, Germany
| | - Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero‑Universitaria Parma, Parma, Italy
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Zsolt Janos Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Walter Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ian Civil
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andreas Hecker
- Emergency Medicine Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Luca Ansaloni
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Vanni Agnoletti
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | | | - Ernest Eugene Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
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Huang J, Xu D, Li X. Indocyanine green-negative counterstaining-guided laparoscopic segment 4 resections for hepatic carcinoma. Asian J Surg 2023; 46:4643-4644. [PMID: 37236821 DOI: 10.1016/j.asjsur.2023.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Affiliation(s)
- Jie Huang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China.
| | - Dingwei Xu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China
| | - Xincheng Li
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650102, Yunnan, China
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Hashimoto T, Osaki T, Oka S, Fujikawa T. Thoracoscopic and laparoscopic approach for pleuroperitoneal communication under peritoneal dialysis: a report of four cases. Surg Case Rep 2023; 9:55. [PMID: 37029287 PMCID: PMC10082140 DOI: 10.1186/s40792-023-01635-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Pleuroperitoneal communication (PPC) is a rare complication of continuous ambulatory peritoneal dialysis (CAPD) and often forces patients to switch to hemodialysis. Some efficiencies of video-assisted thoracic surgery (VATS) for PPC have been reported recently; however, there is no standard approach for these complications. In this case series, we present a combined thoracoscopic and laparoscopic approach for PPC in four patients to better assess its feasibility and efficiency. CASE PRESENTATION Clinical characteristics, perioperative findings, surgical procedures, and clinical outcomes were retrospectively analyzed. We combined VATS with a laparoscopic approach to detect and repair the diaphragmatic lesions responsible for PPC. We first performed pneumoperitoneum in all patients following thoracoscopic exploration. In two cases, we found bubbles gushing out of a small pore in the central tendon of the diaphragm. The lesions were closed with 4-0 non-absorbable monofilament sutures, covered with a sheet of absorbable polyglycolic acid (PGA) felt, and sprayed with fibrin glue. In the other two cases without bubbles, a laparoscope was inserted, and we observed the diaphragm from the abdominal side. In one of the two cases, two pores were detected on the abdominal side. The lesions were closed using sutures and reinforced using the same procedure. In one case, we failed to detect a pore using VATS combined with the laparoscopic approach. Therefore, we covered the diaphragm with only a sheet of PGA felt and fibrin glue. There was no recurrence of PPC, and CAPD was resumed at an average of 11.3 days. CONCLUSIONS The combined thoracoscopic and laparoscopic approach is an effective treatment for detecting and repairing the lesions responsible for PPC.
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Affiliation(s)
- Teppei Hashimoto
- Department of Thoracic Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka, 802-8555, Japan.
| | - Toshihiro Osaki
- Department of Thoracic Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka, 802-8555, Japan
| | - Soichi Oka
- Department of Thoracic Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka, 802-8555, Japan
| | - Takahisa Fujikawa
- Department of Gastroenterological Surgery, Kokura Memorial Hospital, 3-2-1, Asano, Kokurakita-ku, Kitakyuusyu-shi, Fukuoka, 802-8555, Japan
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Costa G, Fransvea P, Lepre L, Liotta G, Mazzoni G, Biloslavo A, Bianchi V, Occhionorelli S, Costa A, Sganga G. Perforated peptic ulcer (PPU) treatment: an Italian nationwide propensity score-matched cohort study investigating laparoscopic vs open approach. Surg Endosc 2023:10.1007/s00464-023-09998-5. [PMID: 36944740 PMCID: PMC10030074 DOI: 10.1007/s00464-023-09998-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/27/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) remain a surgical emergency accounting for 37% of all peptic ulcer-related deaths. Surgery remains the standard of care. The benefits of laparoscopic approach have been well-established even in the elderly. However, because of inconsistent results with specific regard to some technical aspects of such technique surgeons questioned the adoption of laparoscopic approach. This leads to choose the type of approach based on personal experience. The aim of our study was to critically appraise the use of the laparoscopic approach in PPU treatment comparing it with open procedure. METHODS A retrospective study with propensity score matching analysis of patients underwent surgical procedure for PPU was performed. Patients undergoing PPU repair were divided into: Laparoscopic approach (LapA) and Open approach (OpenA) groups and clinical-pathological features of patients in the both groups were compared. RESULTS A total of 453 patients underwent PPU simple repair. Among these, a LapA was adopted in 49% (222/453 patients). After propensity score matching, 172 patients were included in each group (the LapA and the OpenA). Analysis demonstrated increased operative times in the OpenA [OpenA: 96.4 ± 37.2 vs LapA 88.47 ± 33 min, p = 0.035], with shorter overall length of stay in the LapA group [OpenA 13 ± 12 vs LapA 10.3 ± 11.4 days p = 0.038]. There was no statistically significant difference in mortality [OpenA 26 (15.1%) vs LapA 18 (10.5%), p = 0.258]. Focusing on morbidity, the overall rate of 30-day postoperative morbidity was significantly lower in the LapA group [OpenA 67 patients (39.0%) vs LapA 37 patients (21.5%) p = 0.002]. When stratified using the Clavien-Dindo classification, the severity of postoperative complications was statistically different only for C-D 1-2. CONCLUSIONS Based on the present study, we can support that laparoscopic suturing of perforated peptic ulcers, apart from being a safe technique, could provide significant advantages in terms of postoperative complications and hospital stay.
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Affiliation(s)
- Gianluca Costa
- Surgery Center, Colorectal Surgery Research Unit - Fondazione Policlinico Universitario Campus Bio-Medico, University Campus Bio-Medico of Rome, Rome, Italy
| | - Pietro Fransvea
- Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Luca Lepre
- General Surgery Unit, Santo Spirito in Sassia Hospital, ASL Roma 1, Rome, Italy
| | - Gianluca Liotta
- General and Emergency Surgery Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Gianluca Mazzoni
- General Surgery Unit, G.B. Grassi Hospital, ASL Roma 3, Rome, Italy
| | - Alan Biloslavo
- Department of General Surgery, Cattinara University Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Valentina Bianchi
- Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Savino Occhionorelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Surgery, University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Alessandro Costa
- UniCamillus School of Medicine - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma - Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy
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9
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Huang J, Xu D, Li X. Fluorescence-guided laparoscopic liver resection of caudate lobe for hepatic cystadenoma: A video article. Asian J Surg 2023:S1015-9584(23)00164-1. [PMID: 36805723 DOI: 10.1016/j.asjsur.2023.01.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
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10
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Aussilhou B, Ftériche FS, Bouquot M, Lesurtel M, Sauvanet A, Dokmak S. Laparoscopic pancreatic enucleation: cystic lesions and proximity to the Wirsung duct increase postoperative pancreatic fistula. Surg Endosc 2023; 37:544-555. [PMID: 36002687 DOI: 10.1007/s00464-022-09527-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 07/31/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Risk factors for postoperative pancreatic fistula (POPF) following pancreatic enucleation by the open approach (OpenEN) are well known. However, ENs are more frequently performed laparoscopically (LapEN). The aim of this study was to analyze the risk factors of POPF following LapEN. METHODS AND PATIENTS All patients in our prospective database who underwent LapEN were evaluated. We report the demographics, surgical, early and long-term outcomes. Numerous variables were analyzed to identify the risk factors of POPF. RESULTS From 2008 to 2020, 650 laparoscopic pancreatic resections were performed including 64 EN (10%). The median age was 51 years old (17-79), median BMI was 24 (19-48), and 44 patients were women (69%). The main presentation was an incidental diagnosis (n = 40; 62%), pain (n= 10;16%), and hypoglycemia (n = 8;12%). The main indications were neuroendocrine tumors (40; 63%), mucinous cystadenomas (15; 23%), intraductal papillary mucinous neoplasie (3; 5%), and other benign cysts (6; 9%). Lesions were located on the distal pancreas (43; 67%), head (n = 17; 27%), and neck (4; 6%). The median size was 20 mm (9-110); 30 mm (20-110) for mucinous cystadenoma and 18 mm (8-33) for NET. The median operative time was 90 mn (30-330), median blood loss was 20 ml (0-800) ml, and there were no transfusions and one conversion. There were no mortalities and overall morbidity (n = 22; 34%) included grades B and C POPF (10;16%) and post-pancreatectomy hemorrhage (4; 6%). The median hospital stay was 7 days (3-42). There were no invaded lymph nodes and all cystic lesions were nonmalignant. After a mean follow-up of 24 months, there was no recurrence. The risk factors for grades B/C POPF were mucinous cystadenoma and proximity to the Wirsung duct < 3 mm. CONCLUSION In this series, the outcome of LapEN was excellent with no mortality and a low rate of morbidity. However, the risk of POPF is increased with cystic lesions and those close to the Wirsung duct.
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Affiliation(s)
- Béatrice Aussilhou
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France
| | - Fadhel Samir Ftériche
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France
| | - Morgane Bouquot
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France.,University of Paris Cité, Paris, France
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France.,University of Paris Cité, Paris, France
| | - Alain Sauvanet
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France.,University of Paris Cité, Paris, France
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, AP-HP, Hôpital Beaujon, Clichy, France.
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Aliyev V, Piozzi GN, Bulut A, Guven K, Bakir B, Saglam S, Goksel S, Asoglu O. Robotic vs. laparoscopic intersphincteric resection for low rectal cancer: a case matched study reporting a median of 7-year long-term oncological and functional outcomes. Updates Surg 2022; 74:1851-1860. [PMID: 36198884 DOI: 10.1007/s13304-022-01396-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/29/2022] [Indexed: 02/01/2023]
Abstract
Aim of this study was to compare operative, long-term oncological and functional outcomes of laparoscopic (LISR) and robotic (RISR) intersphincteric resection in low-lying rectal cancer. Retrospective analysis of prospectively maintained database was performed. 115 cases (LISR, n = 55; RISR, n = 60) were performed by a single surgeon (January 2011-January 2020). Clinical characteristics did not differ between the groups. Operating time was longer in RISR (160.0 ± 45.7 vs. 205.0 ± 36.5 min, p = 0.035). There was no conversion in RISR, whereas in LISR, two patients (3.6%) converted to open surgery. Complete mesorectum was 61.8% and 83.3% for LISR and RISR (p = 0.046), respectively. Circumferential radial margin involvement was 10.9% and 8.3% in LISR and RISR (p = 0.365), respectively. Median follow-up was 82.8 (30-138) months for LISR and 83.6 (30-138) months for RISR. Three-, five-, and seven-year overall survival rates (OS) for LISR and RISR were: 88.6%, 80.4%, 73.4% and 90.4%, 86.3%, 76.9%, respectively. Three-, five-, and seven-year disease-free survival (DFS) rates for LISR and RISR were 80.5%, 75.2%, 70.4% and 84.4%, 81.4%, 79.8% (p = 0.328), respectively. Three-, five-, and seven-year local recurrence-free survival rates in LISR and RISR were: 96.1%, 92.6%, 88.4% and 96.7%, 94.2%, 90.4% (p = 0.573), respectively. Mean Wexner score for LISR (n = 32) and RISR (n = 40) was: 10.5 ± 4.7 and 9.8 ± 4.2 (p = 0.782), respectively. Colostomy-free survival in LISR and RISR was: 3 years 94.5%/95.2%, 5 years 89.1%/91.7%, and 7 years 83.6%/85.0%. RISR is associated with better mesorectal integrity, no conversion, and lower postoperative complication rate. RISR has longer operation time. Oncological and anorectal functional outcomes are similar in both groups.
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Affiliation(s)
- Vusal Aliyev
- Bogazici Academy for Clinical Sciences, General Surgery, Istanbul, Turkey
| | - Guglielmo Niccolò Piozzi
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Alisina Bulut
- Bogazici Academy for Clinical Sciences, General Surgery, Istanbul, Turkey
| | - Koray Guven
- Department of Radiology, Acibadem Mehmet Ali Aydınlar University School of Medicine, Istanbul, Turkey
| | - Baris Bakir
- Department of Radiology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Sezer Saglam
- Department of Medical Oncology, Demiroglu Bilim University, Istanbul, Turkey
| | - Suha Goksel
- Department of Pathology, Maslak Acibadem Hospital, Istanbul, Turkey
| | - Oktar Asoglu
- Bogazici Academy for Clinical Sciences, General Surgery, Istanbul, Turkey.
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12
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Kawano T, Souzaki R, Sumida W, Ishimaru T, Fujishiro J, Hishiki T, Kinoshita Y, Kawashima H, Uchida H, Tajiri T, Yoneda A, Oue T, Kuroda T, Koshinaga T, Hiyama E, Nio M, Inomata Y, Taguchi T, Ieiri S. Laparoscopic approach for abdominal neuroblastoma in Japan: results from nationwide multicenter survey. Surg Endosc 2021; 36:3028-3038. [PMID: 34143289 DOI: 10.1007/s00464-021-08599-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some neuroblastoma (NB) cases are suitable for minimally invasive surgery (MIS), but indication and technical issue are unclear. We assessed the current status of MIS for abdominal NB after mass screening period in Japan. METHODS Preliminary questionnaires requesting the numbers of NB cases that underwent MIS from 2004 to 2016 were sent to 159 Japanese institutes of pediatric surgery. The secondary questionnaires were then sent to the institutions that reported MIS cases of NB in order to collect detailed data. RESULTS One hundred and thirty-four (84.2%) institutions responded to the preliminary questionnaires, and 83 (52.2%) reported managing operative cases. The total number of operative cases was 1496. MIS was performed for 175 (11.6%) cases, of which the completed forms of 140 patients were returned, including 100 abdominal NB cases. The male/female ratio was 51/49. Forty-seven cases underwent a laparoscopic biopsy, and 2 (4.3%) cases were converted to laparotomy due to bleeding. Sixty-five cases underwent MIS for radical resection, and 7 (10.8%) were converted to laparotomy. The reasons for open conversion were bleeding and severe adhesion. Regarding open conversion, there were no significant relationships between conversion and neo-adjuvant chemotherapy, biopsies, stage, size, or MYCN amplification. We found no relationship between resectability and vascular encasement in this study. There was relationship between the resected tumor size and the patients' height, which was expressed using the following formula: [Formula: see text] (x, patients height, y, tumor size; p = 0.004219, SE: 1.55566). Postoperative complications after radical resection were recognized in 7 (10.8%) cases. CONCLUSIONS MIS was performed in limited cases of abdominal NB. A laparoscopic biopsy with careful attention to bleeding is feasible. The resected tumor size was shown to correlate with the patients' height. Tumor size within 6 cm of maximum diameter can be resected safely.
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Affiliation(s)
- Takafumi Kawano
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima city, 890-8520, Japan
| | - Ryota Souzaki
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuya Ishimaru
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Chiba University, Chiba, Japan
| | | | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akihiro Yoneda
- Division of Surgical Oncology, Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Masaki Nio
- Department of Pediatric Surgery, Tohoku University, Sendai, Japan
| | | | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Medical and Dental Area, Research and Education Assembly, Research Field in Medical and Health Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima city, 890-8520, Japan.
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13
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Wan L, Ran B, Aji T, Shao Y, Jiang T, Wen H. Laparoscopic or open treatment for hepatic alveolar echinococcosis: A single-institution experience. Int J Infect Dis 2021; 107:182-187. [PMID: 33862206 DOI: 10.1016/j.ijid.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficacy of laparoscopy in the treatment of hepatic alveolar echinococcosis (AE). METHODS Between January 2018 and December 2019, 213 hepatic AE patients were admitted to the authors' institution. Among them, 165 patients (77.46%, 165/213) underwent surgery. Of 13 patients who underwent laparoscopic treatment, two required conversion to open surgery. The remaining 11 patients (group 1) were analyzed. During the same period, 154 patients underwent open surgery, but only 14 records were compatible with the criteria for the laparoscopic approach and were reviewed retrospectively (group 2). RESULTS Conversion to open surgery occurred in two cases. Both groups were basically consistent in terms of detailed demographic data, characteristics of the lesions, and surgical strategy (P > 0.05). The laparoscopic group not only achieved the same R0 resection as the open group, but the results were also significantly superior to those of the open group in terms of postoperative complications, postoperative catheterization time, and postoperative hospital stay (P = 0.042, P = 0.046, and P = 0.045, respectively). No recurrences were observed in either group during this period. CONCLUSIONS Laparoscopic surgery provides a safe and efficacious approach for hepatic AE in selected patients. Large, prospective, randomized trials are needed to confirm its superiority.
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Affiliation(s)
- Li Wan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China
| | - Bo Ran
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Xinjiang Hydatid and Hepatobiliary Surgery Medical Centre, Urumqi 830054, PR China
| | - Tuerganaili Aji
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Xinjiang Hydatid and Hepatobiliary Surgery Medical Centre, Urumqi 830054, PR China
| | - Yingmei Shao
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Xinjiang Hydatid and Hepatobiliary Surgery Medical Centre, Urumqi 830054, PR China
| | - Tiemin Jiang
- Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Xinjiang Hydatid and Hepatobiliary Surgery Medical Centre, Urumqi 830054, PR China
| | - Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China; Hepatobiliary and Hydatid Department, Digestive and Vascular Surgery Centre, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, PR China.
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14
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Vanetta C, Paladini JI, Di Menno J, Goransky J, Palavecino M, Arbues G, De Santibañes M, Sánchez-Claria R, Mazza O, Ardiles V, Pekolj J. Role of laparoscopy in the treatment of internal biliary fistulas in a high-volume center and a review of the literature. Surg Endosc 2021; 36:1799-1805. [PMID: 33791855 DOI: 10.1007/s00464-021-08459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Biliary fistulas may result as a complication of gallstone disease. According to their tract, abdominal internal biliary fistulas may be classified into cholecystobiliary and bilioenteric fistulas. Surgical treatment is challenging and requires highly trained surgeons with high preoperative suspicion. Conventional surgery is still of choice by most of the authors. However, laparoscopy is emerging as a minimally invasive alternative. We investigated the surgical approach, conversion rate, and outcomes according to the type of biliary fistula. METHODS We retrospectively reviewed 11,130 laparoscopic cholecystectomies, 31 open cholecystectomies, and 31 surgeries for gallstone ileus at our institution from May 2007 to May 2020. We diagnosed internal biliary fistula in 73 patients and divided them into two groups according to their fistulous tract: cholecystobiliary fistula and bilioenteric fistula. We described demographic characteristics, preoperative imaging modalities, surgical approach, conversion rates, surgical procedures, and outcomes. We additionally revised the literature and compared our results with 13 studies from the past 10 years. RESULTS There were 22 and 51 patients in the cholecystobiliary and bilioenteric groups, respectively. Our preoperative suspicion of a fistula was 80%. We started 88% of procedures by laparoscopic approach. The effectiveness of laparoscopy in the resolution of internal biliary fistula was 40% for cholecystobiliary fistula and 55% for bilioenteric fistulas. The most frequent cause for conversion to laparotomy was the difficulty to identify anatomical features, in addition to the need to perform a Roux en-Y hepaticojejunostomy. Choledocholithiasis was not associated with an increase in conversion rates. CONCLUSIONS Laparoscopic resolution of a biliary fistula is still a matter of controversy. Despite the high conversion rates, we believe that a great number of patients benefit from this minimally invasive technique. A high preoperative suspicion and trained surgeons are vital in the treatment of internal biliary fistulas.
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Affiliation(s)
- Carolina Vanetta
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina. .,Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - José Ignacio Paladini
- Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Juliana Di Menno
- Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Jeremias Goransky
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Martin Palavecino
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Arbues
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Martín De Santibañes
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Sánchez-Claria
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Oscar Mazza
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Juan Pekolj
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
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15
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Cubisino A, Habibeh H, Cubisino R, Navarro F, Panaro F. Combined pancreatojejunal and hepatojejunal anastomotic stent placement in total laparoscopic pancreaticoduodenectomy. Updates Surg 2021; 74:579-581. [PMID: 33721176 DOI: 10.1007/s13304-021-00977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Laparoscopic pancreaticoduodenectomy (LPD) is a technically demanding procedure that is considered safe and feasible if performed in a high-volume institution, where surgeons and medical staff is appropriately trained. For this advanced abdominal procedure only few studies described a reproducible stepwise technique and a standard approach is still lacking. METHODS The attached video reports all steps of our standardized LPD with pancreatojejunal and hepatojejunal anastomotic stent placement performed with a double approach. The laparoscopic demolitive phase, exactly as the laparotomic one, begins with the surgeon placed on the patient's right side, while for the reconstructive one he moves between the patient's legs. The main characteristic of this technique is an easy realization of the end-to-side biliary anastomosis with a Kehr's "T" tube segment placement as internal biliary stent. This easy technical tip can facilitate the anastomosis realization that remains the most challenging step of this laparoscopic technique, especially in case of small common bile duct. RESULTS We consider that our standardized technique can be safely performed and it can facilitate the anastomosis execution, especially the hepatic-jejunal. DISCUSSION Despite our reproducible stepwise technique could help to minimize the learning curve for LPD, further randomized controlled trials are needed to validate the superiority of minimally invasive approach.
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Affiliation(s)
- A Cubisino
- Division of HBP Surgery and Transplantation, Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France.
| | - H Habibeh
- Division of HBP Surgery and Transplantation, Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France
| | - R Cubisino
- Division of HBP Surgery and Transplantation, Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France.,Gastroenterology Unit, IRCCS "Casa Sollievo Della Sofferenza" Hospital, San Giovanni Rotondo, FG, Italy
| | - F Navarro
- Division of HBP Surgery and Transplantation, Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France
| | - F Panaro
- Division of HBP Surgery and Transplantation, Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France
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16
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Lakshmi Narayanan P, C D N, Sekar V, Vadyala AR. Laparoscopic approach to ureteroinguinal hernia. Int J Surg Case Rep 2020; 77:161-164. [PMID: 33166812 PMCID: PMC7653005 DOI: 10.1016/j.ijscr.2020.10.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Herniation of the ureter into the inguinal canal is a rare occurrence. There have been reports of inadvertent injury to the ureter during routine inguinal hernia repair. After an extensive search of the literature, we believe that this is the first case to be managed via laparoscopic Trans Abdominal Pre-Peritoneal Repair and would like to highlight the technical details of the laparoscopic procedure and is presented in line with SCARE 2018 Guidelines [1]. PRESENTATION OF CASE A 60-year-old male presented with left inguinal hernia. He also complained of an increase in frequency of micturition, with an occasional radiating pain from loin to the groin. Imaging revealed the left ureter coursing into the left inguinal canal, descending into the scrotum, and looping back to enter the bladder with mild hydroureteronephrosis. Patient underwent a laparoscopic repair of the inguinal hernia with reduction of ureter under ureteroscope guidance and stent placement. DISCUSSION The presence of ureter buried in a large amount of fat can be mistaken for a lipoma of the cord or extraperitoneal fat and injured with blind clamping and division. Presence of fat without an obvious sac should alert the surgeon to the possibility of ureter being a content. CONCLUSION Laparoscopy is safe, technically feasible, offers good visualization of all hernial orifices, demonstrates complete reduction of ureter from inguinal canal under vision, allows manipulation of ureter under the vision for ureteroscopy and stenting, making sure there are no loops or kinking and allows placement of mesh in the preperitoneal space.
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Affiliation(s)
- Praveen Lakshmi Narayanan
- Department of General Surgery, Sri Ramachandra Institute of Higher Education and Research, No.1, Ramachandra Nagar, Porur, Chennai, 600116, India.
| | - Narayanan C D
- Department of General Surgery, Sri Ramachandra Institute of Higher Education and Research, No.1, Ramachandra Nagar, Porur, Chennai, 600116, India.
| | - Vishnu Sekar
- Department of General Surgery, Sri Ramachandra Institute of Higher Education and Research, No.1, Ramachandra Nagar, Porur, Chennai, 600116, India.
| | - Akshita Reddy Vadyala
- Department of General Surgery, Sri Ramachandra Institute of Higher Education and Research, No.1, Ramachandra Nagar, Porur, Chennai, 600116, India.
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17
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Goméz D, Cabrera LF, Pedraza-Ciro M, Mendoza A, Pulido J. Laparoscopic Roux-en-Y hepaticojejunostomy reconstruction after iatrogenic bile duct injury: case series report. CIR CIR 2020; 88:608-616. [PMID: 33064715 DOI: 10.24875/ciru.20001541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Bile duct injury (BDI) is a devastating complication after a cholecystectomy. Laparoscopic management has become a mainstay approach because of the advantages offered to patients; nevertheless, outcomes after repair are influenced by the center, the surgeon's experience, and the type of reconstruction. Materials and methods Patients with common BDI managed at a referral center from January 2013 to June 2018 with a novel modified and simplified laparoscopic technique for a hepatic duct jejunostomy with a Roux-en-Y reconstruction were retrospectively reviewed. Results Twenty patients had a BDI (20/5430-0.3%), 8 (40%) had intraoperative diagnosis, and 12 (60%) patients with diagnosis before 72 h. Type E Strasberg classification, the predominant BDI was Strasberg E1 (65%), the average surgery time was 146.5 min (115-178 min), the average intraoperative bleeding was 15-50 cc. The overall complication rate was 10 % (2/20), 1 (5%) patient required, there were no mortalities, and the mean hospital stay was 5 days. One (5%) patient presented bile leak (Type SE4), and 1 (5%) patient required intensive care unit admission after reintervention. Long-term follow-up showed no bile duct stricture, cholangitis, or recurrent choledocholithiasis up to 5 years after the procedure and with a minimum of 1 year minimum follow-up. Conclusions This simplified laparoscopic approach to bile duct reconstruction with Roux-en-Y anastomoses appears to be an effective and safe alternative to reconstructive open bile duct surgery, offering to patients the benefits of laparoscopic surgery with a low complication rate.
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Affiliation(s)
- Daniel Goméz
- Department of Advanced Laparoscopic Surgery, Universidad Militar Nueva Granada
| | - Luis F Cabrera
- Department of Surgery, Jose Felix Patiño, Fundación Santa Fe de Bogotá.,Department of General Surgery, Universidad El Bosque
| | | | | | - Jean Pulido
- Department of Medicine, Universidad El Bosque. Bogotá, Colombia
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Liu Z, Tang S, Tian X, Zhao X, Hong P, Zhang Q, Li L, Zhang L, Zhang S, Wang G, Zhang H, Liu C, Zhu G, Ma L. Laparoscopic conversion to open surgery in radical nephrectomy and tumor thrombectomy: causal analysis, clinical characteristics, and treatment strategies. BMC Surg 2020; 20:185. [PMID: 32792015 PMCID: PMC7430843 DOI: 10.1186/s12893-020-00845-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/06/2020] [Indexed: 12/25/2022] Open
Abstract
Background We aimed to explore the causal analysis, clinical characteristics and treatment strategies of laparoscopic conversion to open approach (LCTOA) in radical nephrectomy and tumor thrombectomy. Methods We included all patients with Mayo level I–III renal tumors with inferior vena cava (IVC) tumor thrombus who underwent laparoscopic radical nephrectomy and tumor thrombectomy as the first choice from May 2015 to July 2019. Results There were 70 cases of renal tumor with IVC tumor thrombus treated with a laparoscopic approach as the first choice; 31 Mayo level I, 30 Mayo level II, and 9 Mayo level III. A completely laparoscopic approach was performed in 51 cases (72.9%), and 19 cases (27.1%) underwent active or passive LCTOA. The LCTOA group had higher median preoperative serum creatinine (110.0 μmol/L vs 92.0 μmol/L; P = 0.026), longer postoperative hospital stay (9 days vs 7 days; P = 0.008), longer median operation time (374 min vs 311 min; P = 0.017), higher median intraoperative hemorrhage volume (1300 vs 600 ml; P = 0.020), and higher proportion of male patients (94.7% vs 66.7%; P = 0.016) vs the completely laparoscopic group, respectively. Although preoperative serum creatinine and gender were risk factors in the univariate analysis, multivariate analysis revealed no independent risk factors for LCTOA. We divided the reasons for LCTOA into active conversion and passive conversion; 4 (21.1%) cases underwent active conversion, and 15 (78.9%) underwent passive conversion. Most of the patients undergoing passive conversion had multiple concurrent risk factors, among which perirenal adhesion (30.9%), organ invasion (16.4%), and IVC adhesion (25.5%) were the most common. Fourteen (73.7%) cases underwent renal treatment, and 5 (26.3%) cases underwent tumor thrombus treatment. Conclusions The LCTOA group had a higher median preoperative serum creatinine concentration, longer hospital stay, longer median operation time, and higher median intraoperative hemorrhage volume. However, none of the predictors in our study was an independent risk factor for LCTOA. Perirenal adhesion, organ invasion, and IVC adhesion were the most common causes of LCTOA. Considering the limitations of this study, studies with large sample sizes are required to validate our conclusions.
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Affiliation(s)
- Zhuo Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Shiying Tang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Xiaojun Tian
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Qiming Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Liwei Li
- Ultrasound diagnosis Department of Peking University Third Hospital, Beijing, 100083, China
| | - Li Zhang
- Ultrasound diagnosis Department of Peking University Third Hospital, Beijing, 100083, China
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Guoliang Wang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Hongxian Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Cheng Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China
| | - Guodong Zhu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China.
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, P.R. China.
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Tur-Martínez J, García-Olmo DC, Puy S, Muriel P, Protti GP, Boldó A, Gallardo MA, Bazaga S, Pérez-Miranda M, Olsina-Kissler JJ. A new minimally invasive porcine model for the study of intrahepatic bile duct dilatation. Surg Endosc 2020; 35:2817-2822. [PMID: 32556763 DOI: 10.1007/s00464-020-07716-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/09/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) procedures are becoming more frequent nowadays and novel techniques are on the rise. These procedures require high technical experience and complex endoscopic skills. The goal of this study was to develop a new minimally invasive animal model of bile duct dilatation in the pig, in order to offer a new tool for endoscopic and surgical therapy training and to test new therapeutic strategies. METHODS Twenty-five female pigs underwent laparoscopic surgery in order to perform a common hepatic duct ligation. A pre- and postoperative biochemical analyses were performed: glucose, albumin, total bilirubin (TBil), gamma glutamyl transferase (GGT), alkaline phosphatase, and alanine aminotransferase were measured. Surgical time and intra- and postoperative complications were registered. Five to six days after surgery, an EUS was performed to measure intrahepatic duct size (mm). Distance from the bile duct to the EUS transductor was also recorded (mm). T-student for quantitative variables was applied. Statistical significance was defined as p value ≤ 0.05. RESULTS The mean surgical time was 29.5 ± 14.9 min. In five pigs (20%), some mild intraoperative problems occurred. A severe postoperative complication occurred in one animal (4%). No postoperative mortality was registered. Postoperative serum analyses showed an increase in total bilirubin (p = 0.005) and gamma glutamyl transferase levels (p = 0.001). Postoperative EUS showed dilatation of the intrahepatic bile duct in 76% of pigs, with a mean diameter of 9.6 ± 3.6 mm (distance from the gastric wall of 17.0 ± 6.4 mm). CONCLUSION The surgical procedure described here is a safe technique to induce dilatation of the intrahepatic bile ducts in the pig, with a minimally invasive approach and a high efficacy rate. This animal model might be useful for EUS techniques training and for evaluating new therapeutic approaches.
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Affiliation(s)
- Jaume Tur-Martínez
- General Surgery Department, University Hospital Arnau de Vilanova, Lleida, Spain.
- General Surgery Department, University Hospital Mútua Terrassa, Plaça Dr. Robert, 5, 08221, Terrassa, Barcelona, Spain.
| | | | - Sara Puy
- Centre de Recerca Experimental Biomèdica Aplicada (CREBA), IRBLleida, Lleida, Spain
| | - Pablo Muriel
- General Surgery Department, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Gian Pier Protti
- General Surgery Department, University Hospital Arnau de Vilanova, Lleida, Spain
- Centre de Recerca Experimental Biomèdica Aplicada (CREBA), IRBLleida, Lleida, Spain
| | - Alba Boldó
- Centre de Recerca Experimental Biomèdica Aplicada (CREBA), IRBLleida, Lleida, Spain
| | - Mario A Gallardo
- Gastroenterology and Endoscopy Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Sergio Bazaga
- Gastroenterology and Endoscopy Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Manuel Pérez-Miranda
- Gastroenterology and Endoscopy Unit, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Jorge Juan Olsina-Kissler
- General Surgery Department, University Hospital Arnau de Vilanova, Lleida, Spain
- Centre de Recerca Experimental Biomèdica Aplicada (CREBA), IRBLleida, Lleida, Spain
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Castillo Barbosa A, Pérez Rivera CJ, Tellez LJ, Cabrera Rivera P, González-Orozco A, Mosquera Paz M. Left diaphragmatic hernia following thoracoabdominal aortic repair: A case report. Int J Surg Case Rep 2020; 70:209-12. [PMID: 32417740 DOI: 10.1016/j.ijscr.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/11/2020] [Accepted: 04/24/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Diaphragmatic hernias are somewhat rare complications of thoracoabdominal interventions. Given their late clinical manifestations and misdiagnosis, their incidence is unknown. These hernias have a high mortality risk when an emergency intervention is warranted due to complications from visceral strangulation. CASE PRESENTATION We present the case of a 67-year-old male with prior history of thoracoabdominal aortic repair, who reconsults due to upper gastrointestinal bleeding. Upon arrival, imaging shows a left diaphragmatic herniation with migration of the stomach, omentum and spleen to the thoracic cavity. Through laparoscopic approach, a left diaphragmatic hernial defect is identified with protrusion of half the stomach, omentum and the posterior aspect of the spleen with a sub capsular tear. Additionally, a severe adhesion syndrome on the chest wall and diaphragm were also evident, with entrapment of the inferior lobe of the left lung. The contents were successfully reduced, however pulmonary decortication and extensive adhesiolysis through thoracoscopy was required for complete extraction, enabling a primary repair without tension. CONCLUSIONS We present an infrequent pathology without an established incidence, which has relevant clinical and surgical implications at any level of care, in this case requiring interdisciplinary management. The suspicion of diaphragmatic hernia in a patient with past medical history of thoracoabdominal aortic repair with non-specific gastrointestinal symptoms is essential. We emphasize the importance of clinical suspicion of this complication once the surgical precedent has been identified.
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Siddharth A, Hussain MJ, Cartwright R, Jackson S, Price N. A novel technique for complete laparoscopic excision of a transobturator sling with lower urinary tract mesh erosion. Int Urogynecol J 2020; 31:839-841. [PMID: 32103312 DOI: 10.1007/s00192-020-04264-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 02/11/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To demonstrate a novel technique for complete laparoscopic removal of a transobturator sling for mesh erosion involving a large area of the urethra and bladder neck, without the need for concomitant vaginal dissection. METHOD A 56-year-old woman had a transobturator sling inserted for stress urinary incontinence (SUI) in 2009. In 2017, 8 years following surgery, she experienced groin pain, exacerbated by exercise, and developed recurrent urinary tract infections with dysuria and urethral pain. A cystoscopy demonstrated mesh erosion from the midurethra to bladder neck with a 2-cm calculus formed around the mesh. After careful counselling and discussion at a multi-disciplinary meeting, a decision was made to proceed with laparoscopy with a view to remove the mesh completely. The mesh was removed from the points of erosion into the urethra through a total laparoscopic procedure. The patient made a good recovery with no ongoing pain or voiding difficulties. CONCLUSION Combined approaches for complete excision of transobturator slings, including bilateral inguinal dissection, are relatively morbid with prolonged recovery time and in most centres will require involvement of plastic surgeons. The laparoscopic approach not only allows for the mesh to be removed in total (including the intramural portion of the mesh), but also provides magnified views compared with open surgery and thus allows for better identification of planes and dissection. It also has the added benefit of avoiding vaginal incisions and therefore reducing the risk of fistula formation between the urethra/bladder and vagina.
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Affiliation(s)
- Aditi Siddharth
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
| | - Mohammed J Hussain
- Milton Keynes Hospital NHS Foundation Trust, Standing Way, Eaglestone, Milton Keynes, MK6 5LD, UK
| | - Rufus Cartwright
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Simon Jackson
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
| | - Natalia Price
- John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK
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de la Fuente Hernández N, Martínez Sánchez C, Solans Solerdelcoll M, Hernández Casanovas P, Bollo Rodríguez J, Gaya Sopena JM, Targarona Soler E. Colovesical Fistula: Applicability of the Laparoscopic Approach and Results According to Etiology. Cir Esp 2020; 98:336-341. [PMID: 31980152 DOI: 10.1016/j.ciresp.2019.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 11/03/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Colovesical fistulae have significant morbidity. The aim of our study was to describe a case series of benign and malignant colovesical fistulae, focusing on the viability of the laparoscopic approach. METHODS We reviewed the characteristics of 34 patients with diverticular and colon adenocarcinoma-related colovesical fistulae treated surgically from January 2001 to March 2018, 28 with elective surgery and 6 by urgent surgery. The diagnosis was established by abdominal CT scan, colonoscopy and cystoscopy. Clinically stable patients, with no retroperitoneal or bladder trigone invasion, were approached laparoscopically. RESULTS There were 13 benign cases (all of them approached by sigmoidectomy), 9 performed by laparoscopy with 3 conversions. Partial cystectomy was done in 11 cases, and in two cases conservative management with urinary catheter. Five laparoscopic approaches were performed in 21 patients diagnosed with malignant colovesical fistula, with 3 conversions and 16 laparotomies. The procedures were sigmoidectomy, left colectomy, anterior resection and pelvic exenteration. All of them required partial or total cystectomy. Sixteen patients had complications, most of which were minor (Clavien-Dindo classificationI-II) and with laparotomy approach. CONCLUSIONS The laparoscopic approach can be feasible in well-selected and stable patients, but we have to take into consideration that the conversion rate can be high and this surgery should be performed by experienced surgeons.
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Affiliation(s)
- Noa de la Fuente Hernández
- Departamento de Cirugía Colorrectal y Hematológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
| | - Carmen Martínez Sánchez
- Departamento de Cirugía Colorrectal y Hematológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Mireia Solans Solerdelcoll
- Departamento de Cirugía Colorrectal y Hematológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Pilar Hernández Casanovas
- Departamento de Cirugía Colorrectal y Hematológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Jesús Bollo Rodríguez
- Departamento de Cirugía Colorrectal y Hematológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - Eduard Targarona Soler
- Departamento de Cirugía Colorrectal y Hematológica, Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
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Karimian F. A commentary on "Laparoscopic repair of perforated peptic ulcer is not prognostic factor for 30-day mortality (a nationwide prospective cohort study)" (Int J Surg 2019; Epub ahead of print, https://doi.org/10.1016/j.ijsu.2019.10.017). Int J Surg 2019; 73:10-11. [PMID: 31778824 DOI: 10.1016/j.ijsu.2019.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 11/13/2019] [Indexed: 11/25/2022]
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Aoun F, Mansour R, Chalouhy C, Ruck JM, Albisinni S, Finianos S, Azar H, Chelala D, Ghorra C, Roumeguere T, Moukarzel M. Comparing laparoscopic and percutaneous renal biopsy for diagnosing native kidney disease: A matched pair analysis. Prog Urol 2019; 29:95-100. [PMID: 30579758 DOI: 10.1016/j.purol.2018.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/25/2018] [Accepted: 10/29/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Percutaneous renal biopsy is a well-established diagnostic procedure in patients with underlying medical renal disease. Aim of this study is to compare the adequacy of the biopsy material, the diagnostic yield, and the complication rates of the trans-peritoneal laparoscopic approach and the image-guided percutaneous approach to renal biopsy in the diagnosis of native kidney disease. METHODS We performed a matched-pair analysis matching 1:3 40 patients who underwent trans-peritoneal laparoscopic renal biopsy to 120 patients who underwent percutaneous renal biopsy in the same years. Patients were retrospectively analyzed. Differences in adequacy of biopsy material (i.e. number of glomeruli, continuous), diagnostic yield (categorical) and postoperative complications across the two groups were assessed using Wilcoxon Rank sum or χ2 test. RESULTS Laparoscopic biopsy was associated with a higher number of harbored glomeruli (median 50, IQR 20-77) compared to the percutaneous approach (median 10, IQR 7-15), P<0.001. Adequate biopsies containing at least ten glomeruli were obtained in a significantly higher percentage of patients in the laparoscopic group versus the percutaneous group (92.5% vs. 57.1%, P<0.001). The laparoscopic approach was also associated with a significantly higher diagnostic yield than the percutaneous approach (82.5% vs. 63.5%, P=0.027). Patients who underwent laparoscopic biopsy had no perioperative or postoperative complications, resulting in a significantly lower complication rate than percutaneous biopsy (0% vs. 4%, P<0.001), particularly in the need for transfusion for post-procedure bleeding (0% vs. 1.8%, P<0.001). CONCLUSIONS In this retrospective matched-pair analysis comparing patients undergoing renal biopsy for medical kidney disease, trans-peritoneal laparoscopic renal biopsy was safer and more effective for the diagnosis of medical renal diseases compared to percutaneous renal biopsy. Prospective trials with a good follow-up are needed to define the best candidate for each approach. LEVEL OF EVIDENCE 4.
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Díaz Vico T, Rodicio Miravalles JL, Sánchez Álvarez E, Moreno Gijón M, Rizzo Ramos A, Turienzo Santos EO, Sanz Álvarez L. Laparoscopic treatment of large bowel obstruction due to a self-locating peritoneal dialysis catheter. Int J Surg Case Rep 2018; 53:207-10. [PMID: 30412921 DOI: 10.1016/j.ijscr.2018.10.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 12/02/2022] Open
Abstract
Intestinal obstruction due to self-locating peritoneal dialysis catheters is an infrequent condition. A 55-year-old patient diagnosed with large bowel obstruction was successfully treated by laparoscopic approach. The weight added to the tip of self-locating catheters can cause different complications, including decubitus ulcers or perforations of soft tissues.
Introduction Peritoneal dialysis has been used in the treatment of end-stage renal disease for a long time. The development of continuous ambulatory peritoneal dialysis (CAPD) has achieved an acceptable device of renal replacement therapy. Presentation of case We report a 55 year-old patient who was initiated on CAPD in February 2016. Three months later, the Tenckhoff catheter was removed due to its malfunction, and a new self-locating peritoneal dialysis catheter was placed in the left side of the abdomen. In September 2016, the patient presented with symptoms of intestinal obstruction. A CT scan revealed a collapsed sigmoid colon with the tungsten tip of the catheter supported on the mesosigmoid as the cause of the occlusion. Discussion Herein, a rare but clinically important case of mechanical large bowel obstruction due to self-locating peritoneal dialysis catheter is presented. The weight added to the tip of the self-locating catheter for the purpose of stretching it, can be dangerous if a displacement takes place. A laparoscopic procedure was performed, resolving the obstruction by reinserting the peritoneal catheter in its right position. Conclusion The weight added to the tip of self-locating catheters is a matter of concern, since intimate contact between the peritoneal catheter and the intestinal wall can result in perforation or intestinal occlusion.
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Fujiwara Y, Higashida M, Kubota H, Watanabe Y, Ueno M, Uraoka M, Okamoto Y, Mineta S, Okada T, Tsuruta A, Kusunoki H, Ueno T. Laparoscopic treatment of median arcuate ligament syndrome in a 16-year-old male. Int J Surg Case Rep 2018; 52:79-83. [PMID: 30336385 PMCID: PMC6197958 DOI: 10.1016/j.ijscr.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/01/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION MALS(Median Arcuate Ligament Syndrome) is rare disease. We experienced the case of MALS and successfully treated by laparoscopic approach. PRESENTATION OF CASE A 16-year-old male was admitted to our hospital with postprandial epigastric pain that had been present for 3 years. Abdominal three-dimensional computed tomographic angiography showed stenosis of the celiac trunk, and abdominal Doppler ultrasonography showed that the blood flow in the celiac trunk varied between inspiration and expiration. Hence, the patient was diagnosed with median arcuate ligament syndrome. Laparoscopic decompression of the celiac trunk was performed by division of the ligament and partial excision of the celiac plexus. Intraoperative Doppler ultrasonography showed markedly improved flow in the celiac artery. The patient was discharged from hospital on postoperative day 7, and has no recurrent symptoms at 12 months postoperatively. DISCUSSION This case was most youngest male MALS treated by laparoscopic approach. CONCLUSION Laparoscopic division of the median arcuate ligament is a minimally invasive, safe, and effective method for decompression of the celiac artery.
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Affiliation(s)
| | | | - Hisako Kubota
- Department of Digestive Surgery, Kawasaki Medical School, Japan
| | | | - Michi Ueno
- Department of Digestive Surgery, Kawasaki Medical School, Japan
| | - Mio Uraoka
- Department of Digestive Surgery, Kawasaki Medical School, Japan
| | - Yuko Okamoto
- Department of Digestive Surgery, Kawasaki Medical School, Japan
| | - Shumei Mineta
- Department of Digestive Surgery, Kawasaki Medical School, Japan
| | - Toshimasa Okada
- Department of Digestive Surgery, Kawasaki Medical School, Japan
| | - Atsushi Tsuruta
- Department of Digestive Surgery, Kawasaki Medical School, Japan
| | | | - Tomio Ueno
- Department of Digestive Surgery, Kawasaki Medical School, Japan
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Hedhli O, Karam G, de Vergie S, Nedellec M, Lefevre M, Bouchot O, Rigaud J, Branchereau J. [Pyelo-ureteral anastomosis, for stenosis of the kidney transplant ureter, by laparoscopic approach with robotic assistance]. Prog Urol 2018; 28:557-559. [PMID: 30217430 DOI: 10.1016/j.purol.2018.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/19/2018] [Accepted: 07/17/2018] [Indexed: 11/26/2022]
Affiliation(s)
- O Hedhli
- Institut de transplantation urologie néphrologie (ITUN), CHU Nantes, 44000 Nantes, France
| | - G Karam
- Institut de transplantation urologie néphrologie (ITUN), CHU Nantes, 44000 Nantes, France
| | - S de Vergie
- Institut de transplantation urologie néphrologie (ITUN), CHU Nantes, 44000 Nantes, France
| | - M Nedellec
- Institut de transplantation urologie néphrologie (ITUN), CHU Nantes, 44000 Nantes, France
| | - M Lefevre
- Institut de transplantation urologie néphrologie (ITUN), CHU Nantes, 44000 Nantes, France
| | - O Bouchot
- Institut de transplantation urologie néphrologie (ITUN), CHU Nantes, 44000 Nantes, France
| | - J Rigaud
- Institut de transplantation urologie néphrologie (ITUN), CHU Nantes, 44000 Nantes, France
| | - J Branchereau
- Institut de transplantation urologie néphrologie (ITUN), CHU Nantes, 44000 Nantes, France; Centre de recherche en transplantation et immunologie UMR 1064, Inserm, université de Nantes, 44000 Nantes, France.
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Ibáñez N, Abrisqueta J, Luján J, Sánchez P, Soriano MT, Arevalo-Pérez J, Parrilla P. Reoperation after laparoscopic colorectal surgery. Does the laparoscopic approach have any advantages? Cir Esp 2017; 96:109-116. [PMID: 29290377 DOI: 10.1016/j.ciresp.2017.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/19/2017] [Accepted: 11/24/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. METHODS Patients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. RESULTS A total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), p<0.05. MPI was higher in OS group (27.31±6.47 [19-35] vs. 18.36±7.16 [11-24], p<0.001). Hospital stay after re-intervention, oral tolerance and surgical wound infection, were favorable in LS (p<0.05 in all cases). In patients with MPI score ≤26, laparoscopic approach showed shorter hospital stay after re-intervention, less stay in the critical care unit after re-intervention, earlier start of oral tolerance and less surgical wound infection (p<0.05). CONCLUSIONS A laparoscopic approach in re-intervention for complications after laparoscopic colorectal surgery associates a faster recovery reflected in a shorter hospital stay, earlier start of oral tolerance and a lower abdominal wall complication rate in patients with low severity index.
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Affiliation(s)
- Noelia Ibáñez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
| | - Jesús Abrisqueta
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Juan Luján
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Pedro Sánchez
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - María Teresa Soriano
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | - Julio Arevalo-Pérez
- Departamento de Radiología, Memorial Sloan-Kettering Cancer Center, Nueva York, Estados Unidos
| | - Pascual Parrilla
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, Murcia, España
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Valiathan G, Wani M, Lanker J, Reddy PK. A Case Series on Superior Mesenteric Artery Syndrome Surgical Management, Single Institution Experience. J Clin Diagn Res 2017; 11:PR01-PR03. [PMID: 28969208 DOI: 10.7860/jcdr/2017/20248.10402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/15/2017] [Indexed: 11/24/2022]
Abstract
Compression of duodenum by Superior Mesenteric Artery (SMA) causing proximal intestinal obstruction is an uncommon condition. Treatment of this condition involves conservative management initially followed by surgical management in those patients who have persistent symptoms. This case series evaluates surgical management and outcome of six patients after one year, who presented with SMA syndrome and describes a brief review of literature. Three patients underwent open duodenojejunostomy and the rest three underwent laparoscopic duodenojejunostomy. All patients had uneventful postoperative recovery. Postoperative requirement of analgesics was less in laparoscopic group versus open group. All the three patients in laparoscopic group could be mobilised out of bed on the day of the surgery itself. Mean duration of hospital stay was seven days for open surgery group and three days for the laparoscopy group. Outcome in terms of resolution of abdomen pain and vomiting was similar in both the groups. Four patients were asymptomatic after one year of follow up. A high index of clinical suspicion is needed for the diagnosis of SMA syndrome. Laparoscopic approach is feasible, safe, less morbid and effective as compared to open surgery. In the presence of facilities and surgical expertise, laparoscopic duodenojejunostomy should be considered the procedure of choice for SMA syndrome. Majority of patients remain symptom free at one year follow up.
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Affiliation(s)
- Gopakumar Valiathan
- Registrar, Department of Surgical Gastroenterology, Apollo Main Hospitals, Chennai, Tamil Nadu, India
| | - Majid Wani
- Registrar, Department of Surgical Gastroenterology, Minimal Access Surgery, Apollo Main Hospitals, Chennai, Tamil Nadu, India
| | - Juneed Lanker
- Registrar, Department of Surgical Gastroenterology, Minimal Access Surgery, Apollo Main Hospitals, Chennai, Tamil Nadu, India
| | - Prasanna Kumar Reddy
- Senior Consultant, Surgical Gastroenterologist and Laparoscopic Surgeon, Department of Surgical Gastroenterology, Apollo Hospitals, Chennai, Tamil Nadu, India
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Ikee T, Onishi S, Mukai M, Kawano T, Sugita K, Moriguchi T, Yamada K, Yamada W, Masuya R, Machigashira S, Nakame K, Kaji T, Ieiri S. A comparison of the characteristics and precision of needle driving for right-handed pediatric surgeons between right and left driving using a model of infant laparoscopic diaphragmatic hernia repair. Pediatr Surg Int 2017; 33:1103-8. [PMID: 28801804 DOI: 10.1007/s00383-017-4144-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We compared the characteristics and precision of right and left needle driving for right-handed pediatric surgeons using a laparoscopic diaphragmatic repair model. METHODS Eighteen right-handed pediatric surgeons performed three needle driving maneuvers using both hands. We evaluated the required time and conducted an image analysis. The total path length, velocity, and acceleration of the needle driving were also evaluated. RESULTS Obtained results show the findings for the required time (s, Rt 310.78 ± 148.93 vs. Lt 308.61 ± 122.53, p = 0.93), sum of needle driving balances (mm, Rt 5.23 ± 2.44 vs. Lt 5.05 ± 3.17, p = 0.83), the gap of the needle driving interval (Rt 1.2 ± 0.93 vs. Lt 2.17 ± 1.67, p = 0.04), total path length (mm, Rt 594.03 ± 205.29 vs. Lt 1641.07 ± 670.68, p < 0.01), and average velocity (mm/s, Rt 1.92 ± 0.54 vs. Lt 5.3 ± 1.39, p < 0.01). CONCLUSION For right-handed pediatric surgeons, left needle driving showed almost same quality of right needle driving as regarding the precision. But left needle driving also showed too fast but not economical movement unfortunately, implying rough and risky forceps manipulation. Non-dominant hand training is necessary to avoid organ injury.
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Ahonen-Siirtola M, Rautio T, Biancari F, Ohtonen P, Mäkelä J. Laparoscopic versus Hybrid Approach for Treatment of Incisional Ventral Hernia. Dig Surg 2017; 34:502-506. [PMID: 28376488 DOI: 10.1159/000458713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/30/2017] [Indexed: 12/10/2022]
Abstract
BACKGROUND The aim of this study was to compare the efficacy of a hybrid approach (HA) versus laparoscopy in reducing the risk of complications related to complex adhesiolysis in incisional ventral hernia repair (IVHR). METHODS This study included 269 adult patients who underwent laparoscopic IVHR at the Oulu University Hospital, Finland during 2006-2012. Baseline, operative and postoperative data was collected and compared between the treatment groups; that is, a comparison was made between the laparoscopic approach (LA, 38 patients) and the hybrid approach (HA, 24 patients). RESULTS In the LA group, 11 (28.9%) patients experienced postoperative complications. There were 4 undetected enterotomies that led to major complications, reoperations and one death. In the HA group, 6 (25%) patients experienced mild and moderate complications. During adhesiolysis, 4 enterotomies occurred but were immediately sutured without any complication. CONCLUSION Adhesiolysis through a minimally invasive open technique may be associated with a lower risk of undetected enterotomy in patients with complex adhesions. In IVHR, the hybrid should be considered the operative method of choice when adhesions are foreseeable.
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Abstract
Background and Objectives: Open surgery has been the mainstay treatment for liver hydatidosis in the past. Today, for treatment of simple and uncomplicated cysts, we have a variety of choices: antihelmintic therapy, the PAIR (puncture, aspiration, injection, and respiration) technique, and the laparoscopic approach. We reviewed our series of 267 cases of hepatic hydatidosis submitted to surgery over a period of 20 years, from 1995 through 2014, comparing the results of these minimally invasive treatments. Methods: In 92 patients (25.7% of cases) who presented with complicated liver hydatid cysts, we performed open surgery. In 16.4% of cases (59 patients), we used a laparoscopic approach, and in 208 patients (57.9% of cases), we used the PAIR technique. All patients were monitored after surgery for a mean of 61.7 months (range, 16–127). Postoperative follow-up consisted of clinical examination, laboratory investigation, abdominal ultrasound, and magnetic resonance imaging. Results: Almost all patients (198, 95.2%) treated with the PAIR technique and 55 patients (93.2%) treated with the laparoscopic approach were cured. Six patients (2.8%) from the echo-guided puncture group had to undergo a repeat of the procedure because the cavity did not disappear after 2 years. In 4 patients (2%), we performed open surgery for 2 biliary fistulas and 2 hepatic abscesses. Four patients from the laparoscopic group needed additional procedures. Open surgery was necessary in 2 patients for a recurrence after 2 years; 1 patient had developed a liver abscess and the other had a biliary fistula. Conclusions: In conclusion, open surgery remains the viable option for complicated cysts, with biliary communication, with multiple daughter vesicles, or with calcified walls. For simple, uncomplicated hydatid cysts, both methods (the PAIR technique and laparoscopic procedure) are safe and efficient, with very good results and low morbidity rates.
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Affiliation(s)
- Ciprian Duta
- Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania
| | - Stelian Pantea
- Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania
| | - Caius Lazar
- Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania
| | - Abdullah Salim
- Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania
| | - Daniela Barjica
- Surgical Clinic 2, University of Medicine and Pharmacy, "V. Babes," Timisoara, Romania
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Vanbrugghe C, Lowery AJ, Golffier C, Taieb D, Sebag F. Adrenocortical carcinoma surgery-surgical extent and approach. Langenbecks Arch Surg 2016; 401:991-997. [PMID: 27412357 DOI: 10.1007/s00423-016-1462-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/08/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Adequate tumour resection is the gold standard of care for adrenocortical carcinoma (ACC). However, the optimal surgical strategy remains debatable. In our opinion, the extent of surgery (adequate tumour resection) is the primary concern, rather than the surgical approach (laparoscopic or open). We propose that both surgical approaches have a role in the management of ACC provided the extent of resection is selected based on patient and tumour characteristics and accurate pre-operative investigations. METHODS A review of 25 curative intent resections for ACC between 2002 and 2013 was done. Group A (16 patients-64 %) included all patients who underwent planned radical adrenalectomy without any other resection and group B (9 patients-36 %) included all patients who underwent a planned extensive resection based on pre-operative investigations. RESULTS Of 471 adrenalectomies, 25 were performed for ACC with curative intent. Tumours were significantly larger in group B with mean size of 119.6 versus 62.4 mm in group A (p = 0.002). Tumours in group B also had higher WEISS scores (mean score 7 vs 5.2, p = 0.033) and almost always required multi-organ resection. The recurrence rate was 37.5 % (n = 6) for group A and 44.4 % for group B (n = 4), p = 1.00. Poor prognosis was associated with significantly higher WEISS scores (p = 0.016) and a trend towards more advanced ENSAT disease stage (p = 0.06). Estimated overall survival was 74.17 months (group A 67.3 vs group B 70.1, p = 0.244). CONCLUSIONS Accurate pre-operative staging is critical to select a tailored surgical strategy. Multi-organ resection remains the preferred approach for large and potentially invasive ACC. Some patients presenting with smaller ACC may benefit from a more extensive resection.
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Affiliation(s)
- C Vanbrugghe
- Department of Endocrine Surgery, La Conception University Hospital, 176, boulevard Baille, 13006, Marseille, France.
| | - A J Lowery
- Department of Endocrine Surgery, La Conception University Hospital, 176, boulevard Baille, 13006, Marseille, France
| | - C Golffier
- Department of Endocrine Surgery, La Conception University Hospital, 176, boulevard Baille, 13006, Marseille, France
| | - D Taieb
- Department of Nuclear Medicine, La Timone University Hospital, 264, rue Saint-Pierre, 13005, Marseille, France
| | - F Sebag
- Department of Endocrine Surgery, La Conception University Hospital, 176, boulevard Baille, 13006, Marseille, France
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Dokmak S, Aussilhou B, Ftériche FS, de Chaumont A, Malgras B, Belghiti J, Sauvanet A. Laparoscopic pancreaticoduodenectomy: How I do it? (with video). J Visc Surg 2015; 152:393-4. [PMID: 26476676 DOI: 10.1016/j.jviscsurg.2015.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Dokmak
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
| | - B Aussilhou
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - F S Ftériche
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - A de Chaumont
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - B Malgras
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - J Belghiti
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - A Sauvanet
- Service de chirurgie hépato-bilio-pancréatique et de transplantation hépatique, hôpital Beaujon, 100, boulevard du Général-Leclerc, 92110 Clichy, France
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Park KJ, Choi HJ, Kim SH. Laparoscopic approach to mucocele of appendiceal mucinous cystadenoma: feasibility and short-term outcomes in 24 consecutive cases. Surg Endosc 2015; 29:3179-83. [PMID: 25582961 DOI: 10.1007/s00464-014-4050-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mucocele of the appendix is an uncommon condition where luminal distention by mucin is usually attributable to a mucinous cystadenoma. From a surgical standpoint, it is critical that the mucin-filled tumor remains intact during resection. Spillage of mucin into peritoneal cavity may otherwise lead to pseudomyxoma peritonei. Although acute appendicitis is managed successfully by laparoscopic appendectomy, the potential for rupture has fueled concerns over laparoscopic resection of appendiceal mucoceles. Our aim was to evaluate feasibility, safety, and short-term outcomes of laparoscopic resection in patients with a mucocele of appendix secondary to mucinous cystadenoma. METHODS Data collected prospectively at the Department of Surgery from October 2005 to December 2013 were reviewed, selecting all instances of preoperatively identified appendiceal mucoceles, which was confirmed as mucinous cystadenomas by histology after elective laparoscopic surgery. Patient demographics, surgical data (operative procedures and times, intraoperative complications), and short-term postoperative outcomes were analyzed retrospectively. RESULTS Twenty-four consecutive patients (female 14) were studied. Mean age was 60.0 years (range 42-81 years). Surgical procedures included simple appendectomy (1/24, 4.2 %), partial cecectomy (15/24, 62.5 %), and ileocecal resection (8/24, 33.3 %). Mean operative time was 108.5 min (range 40-205 min). No intraoperative spillage of mucin occurred due to inadvertent rupture of tumor. Resection margins uniformly were negative for tumor. Mean maximal length and diameter of tumors were 7.9 cm (range 3.0-20.0 cm) and 3.2 cm (range 1.0-7.5 cm), respectively. One patient (4.2 %) suffered postoperative morbidity (wound infection). CONCLUSIONS A laparoscopic approach proved feasible and safe for surgical management of appendiceal mucocele due to mucinous cystadenoma. However, long-term follow-up is warranted for more conclusive support.
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Affiliation(s)
- Ki-Jae Park
- Department of Surgery, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 602-715, Korea.
| | - Hong-Jo Choi
- Department of Surgery, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 602-715, Korea.
| | - Sung-Heun Kim
- Department of Surgery, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 602-715, Korea
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Mancini S, Bulotta AL, Molinaro F, Ferrara F, Tommasino G, Messina M. Surgical retroperitoneoscopic and transperitoneoscopic access in varicocelectomy: duplex scan results in pediatric population. J Pediatr Urol 2014; 10:1037-42. [PMID: 24786532 DOI: 10.1016/j.jpurol.2014.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 02/21/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This is a retrospective study to compare duplex scan results of laparoscopic Palomo's technique through retroperitoneal and transperitoneal approach for varicocelectomy in children. We statistically analyzed recurrence, testicular volume growth and complications. PATIENTS AND METHODS Surgical intervention was performed utilizing transperitoneoscopic (group A) or retroperitoneoscopic access (group B). Duplex scan control was performed after 12 months (T1), after 2 years (T2) and the last one at 18 years old in most patients. Statistical analysis was performed using the t-test for parametric data. Differences in proportions were evaluated using χ2 or Fisher's exact test. RESULTS We treated 120 children (age range 10-17 years) who presented an asymptomatic IV grade of reflux, Coolsaet 1, associated with a left testicular hypotrophy in 36.6% of the cases (44 patients). No post-operative complications were verified. Duplex scan exam showed an increase of left testicular growth in both groups, with complete hypotrophy disappear in patients in both groups after 24 months. Hydrocele, diagnosed clinically and confirmed with duplex scan, was the most frequent post-operative complication (22/120 cases; 18.3%). CONCLUSIONS This study showed the importance of duplex scan at all steps of this vascular pathology in children, and that there is no significantly difference in results between the two surgical techniques except for hydrocele in transperitoneoscopic access.
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Affiliation(s)
- Stefano Mancini
- Section of Phlebology, Department of General and Specialistic Surgery, University of Siena, 53100 Siena, Italy
| | - Anna Lavinia Bulotta
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy.
| | - Francesco Molinaro
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy
| | - Francesco Ferrara
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy
| | - Giulio Tommasino
- Section of Phlebology, Department of General and Specialistic Surgery, University of Siena, 53100 Siena, Italy
| | - Mario Messina
- Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Policlinico "Le Scotte" Viale Bracci, 53100 Siena, Italy
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Perin A, Cola R, Favretti F. Accessory wandering spleen: Report of a case of laparoscopic approach in an asymptomatic patient. Int J Surg Case Rep 2014; 5:887-9. [PMID: 25460427 DOI: 10.1016/j.ijscr.2014.10.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 10/12/2014] [Accepted: 10/12/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Accessory wandering spleen is a rare but dangerous condition. Abnormalities of the ligamentous apparatus of an accessory spleen may evolve into torsion of its vascular axis, which can lead to a splenic infarct making surgery necessary. Patients are often asymptomatic and the diagnosis can be accidental. An early diagnosis and a correct treatment are fundamental. PRESENTATION OF CASE In this case report a young woman underwent laparoscopic surgery after an incidental finding at a Pelvic Ultrasound of an accessory wandering spleen. DISCUSSION In literature are reported cases of asymptomatic patients with an accessory wandering spleen treated with a conservative approach. However, a torsion or infarct of the accessory wandering spleen leads to emergency surgery. The presence of an independent vascular axis of the accessory spleen reduces the risk of postoperative complications (e.g. thrombocytosis) and the administration of low molecular weight heparin should prevent the risk of portal thrombosis. CONCLUSION We suggest performing surgery with a laparoscopic approach in patients with accessory wandering spleen, though asymptomatic, because of the risk of serious complications in case of accessory spleen torsion.
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Munkedal DLE, West NP, Iversen LH, Hagemann-Madsen R, Quirke P, Laurberg S. Implementation of complete mesocolic excision at a university hospital in Denmark: An audit of consecutive, prospectively collected colon cancer specimens. Eur J Surg Oncol 2014; 40:1494-501. [PMID: 24947074 DOI: 10.1016/j.ejso.2014.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/21/2014] [Accepted: 04/08/2014] [Indexed: 02/07/2023] Open
Abstract
AIM Over recent years there has been a new focus on the quality of colon cancer surgery following the description and introduction of complete mesocolic excision (CME). In the same period, laparoscopic surgery has been widely applied to the treatment of colon cancer. We aimed to evaluate the introduction of both CME and laparoscopic-assisted surgery at Aarhus University Hospital, Denmark between 2008 and 2011. Secondly we aimed to evaluate the impact on the quality of surgery of post-operative team meetings where pathologists demonstrated the plane of surgery on the specimens. METHOD A series of 209 consecutive and prospectively collected colon cancer specimens were evaluated by assessing the plane of surgery and measuring the amount of tissue resected. Multivariate analyses were used to control for influencing factors. RESULTS The proportion of specimens resected in the mesocolic plane was high and increased significantly following the introduction of post-operative team meetings (52%-76%, p = 0.02). Laparoscopic surgery enhanced the distance between the tumour and the arterial tie by a mean of 27 mm (p < 0.0001) and the distance between the nearest bowel wall and the arterial tie by 26 mm (p < 0.0001) when compared to an open approach. Factors such as body mass index and age influenced the outcome for surgical quality. CONCLUSION Implementation of CME and laparoscopic-assisted surgery for colon cancer is a challenge and requires continuous training and feedback. Post-operative multidisciplinary team meetings may be a key element in this process.
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Affiliation(s)
- D L E Munkedal
- Department of Surgery P, Aarhus University Hospital, 8000 Aarhus C, Denmark.
| | - N P West
- Pathology, Anatomy & Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Leeds LS9 7TF, UK.
| | - L H Iversen
- Department of Surgery P, Aarhus University Hospital, 8000 Aarhus C, Denmark.
| | - R Hagemann-Madsen
- Pathology Department, Aarhus University Hospital, 8000 Aarhus C, Denmark.
| | - P Quirke
- Pathology, Anatomy & Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, St. James's University Hospital, Leeds LS9 7TF, UK.
| | - S Laurberg
- Department of Surgery P, Aarhus University Hospital, 8000 Aarhus C, Denmark.
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Fortea-Sanchis C, Priego-Jiménez P, Martínez-Ramos D, Ángel-Yepes V, Villegas-Cánovas C, Escrig-Sos J, Salvador-Sanchis JL. [A preliminary experience in the laparoscopic approach to bowel obstruction]. Rev Gastroenterol Mex 2013; 78:219-24. [PMID: 24290722 DOI: 10.1016/j.rgmx.2013.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/02/2013] [Accepted: 07/06/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND The laparoscopic approach to bowel obstruction is still controversial. OBJECTIVE To evaluate our initial results in the laparoscopic treatment of bowel obstruction. MATERIAL AND METHODS A retrospective study on patients diagnosed with bowel obstruction that underwent laparoscopic surgery within the time frame of January 2008 to June 30, 2012. The variables employed were: age, sex, occlusion etiology, previous surgeries, clinical progression, pneumoperitoneum creation, use of an auxiliary incision, anesthesia duration, conversion rate, postoperative hospital stay, time needed to tolerate liquids, and complications. RESULTS Twenty-six patients, 18 women (69.2%) and 8 men (30.8%), with a mean age of 64.35 years (range: 21-92 years) were analyzed. The most frequent obstruction etiology was secondary to adhesions and presented in 12 cases. Nine patients (34.6%) underwent a completely laparoscopic approach and laparoscopy was complemented by an auxiliary incision in another 9 patients (34.6%), resulting in 18 cases (69.2%) of successful laparoscopic approach. Eight patients (30.8%) required conversion to open surgery. The mean anesthesia duration was 95min (range: 55-165min), mean postoperative hospital stay was 6 days (range: 3-72 days), and the mean amount of time needed to tolerate liquids was 3 days (range: 1-10 days). The patients that underwent complete laparoscopic approach presented with shorter hospital stay, they were able to ingest liquids earlier, and they presented with a lower number of postoperative complications; this latter variable was the only one that was statistically significant. CONCLUSIONS The initial results of our experience were good, although more patients are needed in order to standardize and extend the use of this technique.
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Affiliation(s)
- C Fortea-Sanchis
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España.
| | - P Priego-Jiménez
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
| | - D Martínez-Ramos
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
| | - V Ángel-Yepes
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
| | - C Villegas-Cánovas
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
| | - J Escrig-Sos
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
| | - J L Salvador-Sanchis
- Servicio de Cirugía General y Digestiva, Hospital General de Castellón, Castellón, España
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Nari GA, Palacios Rodriguez Ó, Russo N, Figueras J. Laparoscopic approach to liver hydatidosis: initial experience. Cir Esp 2015; 93:248-51. [PMID: 24199733 DOI: 10.1016/j.ciresp.2013.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/21/2013] [Accepted: 06/09/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Hepatic hydatidosis is a pathology that has a worldwide distribution, and is frequent in some rural areas in Argentina. Surgical treatment still offers the best results. The laparoscopic approach is controversial because of lack of experience with this technique. OBJECTIVE To evaluate the feasibility and efficacy of the laparoscopic approach in this pathology and to present the experience obtained in a medical center in Argentina. MATERIAL AND METHODS We prospectively evaluated patients with a diagnosis of non complicatedhydatidosis, over 15 years of age whose cyst had the following characteristics: unique cyst, size less than 5 centimeters, located in the anterior segments or easy access. Analyzed data were: sex, age, cyst localization, treatment, operating time, morbidity and mortality and recurrence. RESULTS Nine patients were operated using a laparoscopic approach. The cysts were localized in the segments iii, iv, v and vi. Six patients were operated with pneumoperitoneum and 3 with a parietal traction device, in all the patients the first approach was a laparoscopic PAIR (punction, aspiration, injection and reaspiration). Seven Mabit-Lagrot procedures were performed and 2pericystectomies. The operative time was a mean of 89.7min and a hospital stay of 52h. The morbidity was 22.2% and the mortality was 0%.Mean follow-up of 19 months showed no recurrences. CONCLUSION A higher number of patients and a longer follow-up are necessary to evaluate the efficacy of approach; the laparoscopic approach seems to be safe. Our results coincide with the majority of other publications.
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Abstract
Tailgut cysts, or retrorectal cystic hamartomas, are rare congenital developmental lesions, most commonly located in the retrorectal space, and are more common in women. We present a case of retrorectal tailgut cyst managed using a laparoscopic approach. A 36-year-old woman presented with incidentally detected retrorectal tumors during evaluation for a gallbladder polyp. Her past medical history revealed that she had undergone cesarean section twice. The tumor marker CA 19-9 level was 42.52 U/ml. CT of the pelvis with contrast and pelvic MRI revealed a 3.9 × 3.3 cm well-defined, homogeneous cystic mass in the right presacral area, and a 2.5 × 1.5 cm cystic mass in the precoccygeal space. The patient underwent laparoscopic exploration with a preoperative diagnosis of tailgut cysts based on radiological findings. The operative time was 90 min including 30 min of subsequent laparoscopic cholecystectomy without placement of additional trocars. The surgical specimens consisted of two fragments of fibrofatty tissues, unilocular cystic masses. The final pathologic diagnosis was tailgut cysts with no evidence of malignancy. Postoperative recovery was uneventful, and the patient was discharged after 3 days. In conclusion, surgical resection is recommended in the management of retrorectal tailgut cyst to establish a definite diagnosis and to rule out malignancy. The laparoscopic approach is a feasible and safe option.
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Affiliation(s)
- S W Lim
- Department of Surgery, Chonnam National University Hwasun Hospital, Gwangju, South Korea
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