Transplantation - CRSLS

Laparoscopic Repair of Diaphragmatic Hernia after Left Ventricular Assist Device Explantation

SLS — Mon, 01 Aug 2016 17:00:56 +0000

Department of Surgery, Mt. Sinai-St. Luke’s-Roosevelt Hospital Center, New York, New York, USA (all authors).

ABSTRACT

Introduction: Herniation of the bowel through a diaphragmatic defect is a rare cause of abdominal pain and obstruction in the adult patient. Most clinically significant congenital hernias are discovered in childhood, and most acquired traumatic and iatrogenic defects are discovered shortly after the injury, if at all. Delayed symptomatic herniation years after initial insult is an uncommon but well-described complication after diaphragmatic injury.

Case Description: A 34-year-old man presented to the emergency department 10 hours after developing sharp left upper quadrant abdominal pain, accompanied by nausea and dry heaves. His surgical history was significant for sequential left ventricular assist device explantation and orthotopic heart transplantation 2 years prior. A chest radiograph demonstrated a loop of colon in the left chest. The patient was taken to the operating room for emergent laparoscopy, reduction, and repair of an incarcerated diaphragmatic hernia. A laparoscopic approach was used to reduce and evaluate the viscera. The hernia defect, which measured 13 cm2, was then closed primarily with nonabsorbable sutures. The patient was discharged uneventfully on postoperative day 2.

Discussion: Although uncommon, left ventricular assist device placement and explantation can lead to iatrogenic diaphragmatic hernia. The possibility of a diaphragmatic hernia should be considered in any patient presenting with abdominal pain after left ventricular assist device explantation. A laparoscopic repair should be used when possible.

Key Words: Left Ventricular Assist Device, Diaphragmatic Hernia, Heart Transplant.

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Laparoscopic Colectomy for Colon Cancer After Liver Transplantation

SLS — Sat, 15 Nov 2014 19:37:08 +0000

Gustavo Rossi, MD, Ricardo Mentz, MD, Carlos A. Vaccaro, MD, PhD, Fernando A. Alvarez, MD,

Guillermo Ojea Quintana, MDSection of Colon and Rectal Surgery, Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Peron 4190, C1181ACH, Buenos Aires, Argentina (all authors).

ABSTRACTIntroduction: Colon cancer in liver transplant patients is an uncommon clinical situation. These patients are considered of high risk and are classically treated with an open approach. Currently, there are very few reports in the literature regarding laparoscopic colectomy in the case of solid-organ transplant patients and none concerning a straight laparoscopic colectomy in a liver transplant patient.

Case Description: We present a 63-year-old female patient with a history of liver transplantation, who developed a left colon cancer 3 years after surgery. The tumor was located in the sigmoid colon, approximately 20 cm from the anal verge. The serum carcinoembryonic antigen was 4.5 ng/mL and a thoracoabdominal computed tomography scan ruled out metastatic disease. Surgery was scheduled and a laparoscopic left colectomy was successfully performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 3. After a 28-month follow-up, the patient remains free of disease.

Discussion: To the best of our knowledge, the present case represents the first reported straight laparoscopic colectomy in a liver transplant recipient. Laparoscopic colectomy for colon cancer in previous liver transplant patients is feasible and may be safely performed in the hands of experienced colorectal surgeons. Due to the known benefits of laparoscopic surgery, this alternative appears to be worthwhile and should be considered in selected liver transplant patients.

Key Words: Colon cancer, Laparoscopic colectomy, Laparoscopy, Liver transplantation

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Early Hand-Assisted Laparoscopic Resection of Ruptured Hepatocellular Carcinoma

SLS — Sat, 15 Nov 2014 17:56:53 +0000

Brian K. P. Goh, MBBS, MMed, MSc, FRCS, Pierce K. H. Chow, MBBS, MMed, PhD, FRCS

Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore (all authors). Duke–NUS Graduate Medical School, Singapore (all authors).

ABSTRACT

Laparoscopic liver resection has increasingly been used as a therapeutic modality in hepatocellular carcinoma (HCC). However, its use in the treatment of spontaneously ruptured HCC has not been well documented. We describe a case of spontaneously ruptured HCC successfully treated with hand-assisted laparoscopic liver resection.

Key Words: Hand-assisted laparoscopy, Laparoscopy, Hepatectomy, Hepatocellular carcinoma, Ruptured.

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