Articles from November 2014–April 2022 can be found via the Archives links in the sidebar of the CRSLS home page.

The post View Case Reports Published in CRSLS first appeared on JSLS.

Edward Via College of Osteopathic Medicine, Spartanburg, SC, AL. (Dr. Narlapati)
Womack Army Medical Center, Ft Bragg, NC. (Dr. Telian)
Uniformed Services University of the Health Sciences, Bethesda, MD. (Dr. Kaplan)

ABSTRACT
In this report, we present a 38-year-old female with acute cholecystitis, in which an aberrant right hepatic duct draining directly into the cystic duct was revealed by intraoperative cholangiography during a laparoscopic cholecystectomy. This anomaly was classified as the class V variant using the Hisatsugu classification schema, which has an incidence of 1.02%. The use of Strasberg’s critical view of safety has become ubiquitous in laparoscopic cholecystectomy. Intraoperative cholangiography provides and additional layer of safety, and should be considered as a routine practice, particularly when imaging to delineate biliary anatomic aberrancies has not been performed prior to surgery.

Key Words: Aberrant right hepatic duct, Cholangiography, Critical field of view, Laparoscopic cholecystectomy.

The post A Type V Aberrant Right Hepatic Duct Branching from the Cystic Duct: The Paramount Importance of Intraoperative Cholangiography in Supplementing the Critical View of Safety Technique in Laparoscopic Cholecystectomy first appeared on JSLS.

Rowan University School of Osteopathic Medicine, Stratford, NJ. (Drs. Oldewurtel and Ground)
Jefferson Health New Jersey, Department of Surgery, Stratford, NJ. (Dr Neff)

ABSTRACT
Introduction: A de Garengeot’s hernia is a femoral herniacontaining the appendix and accounts for approximately 0.8% of all femoral hernias.

Presentation of the Case: This paper describes a case of an 84-year-old female who presented with abdominal pain, believed to have an incarcerated femoral hernia. Patient underwent a hernia repair and was found to have a femoral hernia involving the appendix, a de Garengeot’s hernia. The femoral hernia was repaired using a total extraperitoneal (TEP) approach.

Discussion: There are a variety of reported ways to repair a de Garengeot hernia. In this case, we discuss the successful use of the TEP approach to repairing a de Garengeot hernia.

Conclusion: Although rare, a de Garengeot hernia must remain on the differential when evaluating a patient for an incarcerated femoral hernia. A TEP approach provides the surgeon the ability to perform a variety of hernia repairs, regardless of what is encountered during the operation.

Key Words: De Garengeot hernia, Total Extraperitoneal, Femoral hernia, Acute appendicitis.

The post De Garengeot Hernia: A Total Extraperitoneal Approach to a Femoral Hernia Repair first appeared on JSLS.

Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX. (Drs. Chamely, Hoang, Felinski, Bajwa, Walker, Wilson, and Shah)
Michael E DeBakey Institute of Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX. (Dr. Jafri)
Radiology Partners, Houston, TX. (Dr. Barge)
Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX. (Dr. Cen)
Michael E DeBakey Institute of Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX. (Dr. Shah)

ABSTRACT
Background: Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incisionless, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.

Case Description: A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical gastrojejunostomy at an outside hospital. His procedure was complicated by anastomotic leak and essentially persistent obstructive symptoms secondary to delayed gastric emptying. Though his anastomosis was demonstrably patent, these symptoms were thought to be secondary to a functional obstruction at the gastrojejunostomy. After repeated workups and many failed attempts to treat these symptoms, he ultimately underwent endoscopic placement of an uncovered colonic stent into the efferent limb of his gastrojejunostomy. This allowed for preferential drainage of gastric contents down the efferent limb, and improvement of his delayed gastric emptying.

Conclusions: In a select group of patients with advanced foregut malignancy, and with high re-operative risks, salvage endoscopic stenting may be useful in the palliation of symptoms from a functionally obstructed gastrojejunostomy.

Key Words: Gastric outlet obstruction, Gastrojejunostomy, Delayed gastric emptying, Endoscopy, Stent.

The post Palliative Endoscopic Salvage of a Functionally
Obstructed Gastrojejunostomy – Report of Technique first appeared on JSLS.

Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA (Drs. Nezhat and Hincapie)
Northwell Health Hospital-Gynecology, Queens County, New York, NY (Dr. Gojayev)
Lenox Hill Hospital- Gynecology, New Hyde Park, New York, NY (Dr. Katz)

ABSTRACT
Objective: Endometriosis spreading to the vagina is rare, present in only 0.02% of women with symptomatic endometriosis. Suburethral lesion site is exceptional. In an extensive literature review only 4 cases of suburethral endometriosis were identified. Our objective is to present a case of primary vaginal suburethral endometriosis in a 31-year old patient who underwent laparoscopic evaluation and to perform a literature review on this topic.

Methods and Procedures: Case report presentation based on information extracted from patient database. A review of literature with a Medline search using key words urethral endometriosis, suburethral endometriosis, or urethral diverticulum was undertaken.

Results: This case report describes a case of a 31-year old female patient referred for severe pelvic pain, worsening during menstruation. On physical examination a 2 cm suburethral endometriotic lesion was found as the initial presentation. Her examination was also significant for enlarged, tender uterus and adnexa. Based on examination and imaging, adenomyosis and endometriosis were suspected. Surgical evaluation revealed extensive endometriosis with lymph node involvement at laparoscopic exploration. The review of literature revealed only 4 cases where suburethral endometriosis was previously identified.

Conclusion: Primary vaginal suburethral endometriosis, although rare, could be an indication of extensive endometriosis. This case highlights the importance of careful clinical examination, surgical excision, and laparoscopic evaluation when identifying suburethral vaginal endometriotic lesions.

Key Words: Endometriosis, Laparoscopy, Suburethral, Surgical management.

The post Suburethral Endometriosis as Clinical Finding of
Extensive Disease first appeared on JSLS.

Department of Surgery, Moinhos de Vento Hospital, Porto Alegre, Brazil (R. Sommer, J.V. Machado Grossi, M.K. Seabra, A.P. Seabra).
Academic of Medicine – Feevale – Novo Hamburgo, Brazil (G.R. Grossi Harada (Medical Student)).
Department of Surgery, Clinicas de Porto Alegre Hospital, Porto Alegre, Brazil (L.
T. Cavazzola).

ABSTRACT
Epiphrenic diverticulum is a rare condition associated with esophageal motor disorder, and it is often asymptomatic, with a well-established surgical indication. The present study aims to report a case of a giant epiphrenic diverticulum in a 68-year-old male patient who, due to the symptoms, opted for surgical treatment using the daVinci® system. Robotic surgery consisting of esophageal diverticulectomy with cardiomyotomy was performed. The patient had an excellent recovery with an abbreviated hospitalization, return to food, and satisfactory routine activity.

Key Words: Chest, Diverticulum, Esophagus, Robotic, Surgery.

The post Treatment of Giant Esophageal Epiphrenic
Diverticulum Using Robotic-Assisted Surgery first appeared on JSLS.

Surgery Department, NYU Langone – Long Island, Mineola, NY. (Drs Silverstein, Liu and Shin)
Staten Island University Hospital, Staten Island, NY. (Dr Berler)

ABSTRACT
Intussusception in adults is a rare occurrence at approximately 5% and malignancy as the cause comprises half that number. The most common malignancies found are primary adenocarcinoma, metastatic carcinoma, lymphoma, and gastrointestinal stromal tumors. Lymphoma is the second most common. The management of adult intussusception is generally surgical, which is due to the higher likelihood of malignancy being the underlying cause. The patient’s history helps to direct management and the most likely underlying diagnosis. This is especially important in patients who are immunosuppressed and with a history of lymphoproliferative disease. Early management and proper surgical intervention allow for the best survival rate. Here we present a case of adult intussusception caused by a rare and aggressive type of non-Hodgkin lymphoma.

Key Words: Adult, Intussusception, Lymphoma, Plasmablastic.

The post Plasmablastic Lymphoma Causing Adult
Intussusception After Cardiac Transplantation first appeared on JSLS.

Department of Surgery, University of Miami Miller School of Medicine (D. Bergholz, T. F. Rasul)

NCH Baker Hospital, Naples (J. R. Obi, R. Grossman)

ABSTRACT
Introduction: Intercostal hernias are a rare clinical entity. They are divided into trans-diaphragmatic intercostal or abdominal intercostal hernias based upon the presence or absence of diaphragmatic injury. There are various means of repair for these hernias, including open, laparoscopic, and robotic approaches. We present the second known robotic repair of an abdominal intercostal hernia and review of the relevant literature.

Case Description: A 54-year-old morbidly obese male was found to have an abdominal intercostal hernia on the right between the 9th and 10th ribs. His symptoms were significant for a large, tender right chest wall mass. Through a three-port approach, polypropylene mesh and circumferential sutures were used to create a double-wall of reinforcement to secure the area of weakness.

Discussion: This rare case of an intercostal hernia utilized robotic-assisted laparoscopic repair and led to a favorable outcome, whereby the patient reported significant improvement in pain, comfort, and quality of life. Thus, minimally invasive robotic surgery for this complex structural pathology can be safer and have less complications than other current treatments.

Key Words: Intercostal, Hernia, Robotic, Laparoscopic, Abdominal.

The post Robotic Repair of an Acquired Abdominal Intercostal Hernia first appeared on JSLS.

Trinity Medical Science University, School of Medicine, (International) Ribishi, St. Vincent and the Grenadines, West Indies, (United States) Roswell, Georgia USA (F. Alyass).
Houston Medical Center, General Surgery, Department of Surgery, Warner Robins, Georgia USA (Dr. P. N. Narh-Martey).

ABSTRACT
Secondary distal plasmacytoma that arise from multiple myeloma is a common hematological malignancy that manifests in later stages of the disease. These plasmacytomas are known to cause extensive systemic organ damage. When extramedullary plasmacytomas reach the gallbladder or biliary ducts, expansion can mimic acute acalculous cholecystitis or cholangiocarcinoma. We report a case of a 56-year-old female with a history of aggressive course IgA k chain multiple myeloma who presented with right upper quadrant abdominal pain with nausea and vomiting for one week duration. Her laboratory panel revealed liver function tests consistent with gallbladder etiology. Abdominal ultrasound and CT showed no evidence of cholelithiasis precluding to acute acalculous cholecystitis. Initial medical management did not show any improvement. A robotic cholecystectomy was performed, and a pathology review of the specimen found a neoplastic stricture of the gallbladder fundus, the histological evaluation of which revealed plasmacytoid cells originating from her primary multiple myeloma diagnosis. The patient’s condition declined following surgery, postoperative presentation included metastatic liver thrombosis mimicking cholangiocarcinoma and the patient later expired with palliative care.

Key Words: Acute cholecystitis, Multiple myeloma, Extramedullary plasmacytoma, Robotic laparoscopy.

The post Multiple Myeloma Plasmacytoid Infiltration of the
Gallbladder Presenting as Acute Cholecystitis first appeared on JSLS.

Department of Surgery, University of New Mexico Hospital, Albuquerque, NM.

ABSTRACT

We report a case of a 21-year-old male who presented with adult-onset dysphagia after previous Nissen fundoplication initially created at age 10.5 months. The patient first presented one year ago to a different hospital, where he underwent extensive workup for his symptomatology. Physiologic tests performed were esophagogastroduodenoscopy (EGD), ab- dominal ultrasound, hepatobiliary iminodiacetic acid scan, esophageal manometry, and lactulose breath test. The EGD identified stricture at the level of the gastroesophageal junction. The other studies did not reveal other physiologic causes for his symptoms. The patient then presented to our institution, at which time a repeat EGD showed evidence of tight Nissen fundoplication. The patient subsequently underwent laparoscopic exploration, which revealed that the fundopli- cation had was partially disrupted, herniated, and twisted causing a long-segment distal stricture. To alleviate the patient’s presenting symptom of dysphagia as well as prevent possible future reflux, it was decided to convert repair the hernia and revise the Nissen into a partial fundoplication. This was successfully accomplished laparoscopically with sub- sequent resolution of the patient’s symptoms.

Key Words: Pediatric GERD, Nissen fundoplication, Toupet fundoplication, Dysphagia.

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The post Laparoscopic Revision of Nissen to Partial Fundoplication 20 Years After Initial Surgery as an Infant first appeared on JSLS.