Department of Obstetrics and Gynecology, and Reproductive Sciences, University of California San Francisco, CA (Drs. Ho, Lager). Northern California Chapter of the American College of Surgeons, and Division of General and Trauma Surgery, Marin General Hospital, Larkspur, CA (Dr. Maa). Department of Surgery, Columbia University, New York, NY (Dr. Liou).

ABSTRACT

The female hydrocele, also known as the canal of Nuck cyst, is a rare congenital abnormality that is the equivalent of the patent processus vaginalis in males. We are the first to report the laparoscopic excision of an entirely extraperitoneal canal of Nuck cyst. We discuss the embryology, pathophysiology, and surgical management of this atypical variant of a rare entity.

Key Words: Canal of Nuck cyst, Hydrocele, Laparoscopic surgery, Processus vaginalis.

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The post Laparoscopic Management of a Canal of Nuck Cyst first appeared on JSLS.

Department of Medical Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence “ICOT,” Sapienza University of Rome, Rome, Italy (Drs. Iossa, Cavallaro, Cereatti, Rizzello, Silecchia). Department of Surgical Sciences and Organ Transplantation—P. Stefanini, Sapienza University of Rome, Rome, Italy (Dr. Fiocca). Vascular and Interventional Unit, Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy (Dr. Corona).

ABSTRACT

Introduction: Endoscopic self-expandable stents are emerging as safe and effective options for the treatment of bariatric surgery complications. Our aim is to report 3 cases of severe complications after self-expandable stent implantation.

Case Description: A retrospective database analysis showed 14 major complications over the past 400 bariatric procedures (3.5%); 8 of them were managed conservatively. Three cases of unusual severe complications after self-expandable stent implantation were observed. In case 1 (leak after resleeving), the self-expandable stent migrated twice and caused an esophageal stenosis, which was treated by endoscopic dilation. Three months later, the stenosis recurred and the patient was a candidate for distal esophagectomy. In case 2 (gastrojejunal stricture after Roux-en-Y gastric bypass), the endoscopic dilation was complicated by perforation and treated with a self-expandable stent. The patient required an emergency laparoscopy to remove the stent that had migrated into the ileum. After 1 month, gastrojejunal stenosis recurred and the patient underwent laparoscopic revision of the anastomosis. In case 3 (leak after vertical banded gastroplasty [VBG]–Roux-en-Y gastric bypass conversion), the self-expandable stent migrated twice and caused an esophageal-pleural fistula managed with a new stent.

Discussion: Bariatric surgeons have to balance the possible advantages of self-expandable stents on a case-by-case basis. Complications of endoscopic stents can be life-threatening and are underestimated and under-reported in the literature.

Key Words: Bariatric surgery complications, Endoscopic management, Stent complication.

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The post Severe Events Related to Use of Stents in Bariatric Surgical Complications first appeared on JSLS.

Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana (both authors).

ABSTRACT

Intra-abdominal adhesions are a common complication of abdominal surgery and can lead to further complications including bowel obstruction, infertility, and pain. We describe a novel technique of performing transvaginal laparoscopic lysis of adhesions following a total vaginal hysterectomy in a 41-year-old woman with periumbilical pain and menorrhagia. This natural orifice transluminal endoscopic surgical procedure was tolerated well, did not add considerable overall operating time, and did not require extensive additional training. The patient reported no periumbilical pain at 1 year.

Key Words: Surgery-induced tissue adhesions, Laparoscopic surgery, Natural orifice transluminal endoscopic surgery, Hysterectomy, Vaginal

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The post Transvaginal Adhesiolysis Using Laparoscopic Instruments first appeared on JSLS.

Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea (all authors).

ABSTRACT

Introduction: Littoral cell angioma of the spleen is an extremely rare primary vascular tumor.

Case Description: We report a case of littoral cell angioma of the spleen with massive splenomegaly. A 37-year-old man with anemia, thrombocytopenia, leukocytosis, and splenomegaly was admitted to our hospital. A computed tomography scan of the abdomen showed multiple hypodense nodules in the spleen, and the size of the spleen was 20 29 cm. The preoperative computed tomography diagnosis was littoral cell angioma of the spleen. We successfully performed hand-assisted laparoscopic splenectomy after splenic artery embolization, and the final diagnosis was littoral cell angioma.

Discussion: HALS with SAE during the appropriate time period is feasible and adequate for LCA with massive splenomegaly.

Key Words: Littoral cell angioma, Hand-assisted laparoscopic splenectomy, Splenic artery embolization, Splenomegaly.

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The post Littoral Cell Angioma of the Spleen With Massive Splenomegaly Treated by Hand-Assisted Laparoscopic Splenectomy After Splenic Artery Embolization first appeared on JSLS.

Easton Hospital, Department of Surgery, Drexel University College of Medicine, Easton, Pennsylvania, USA (all authors).

ABSTRACT

Introduction: Lipomas of the intestinal tract are rare, but they present as the third most common cause of intestinal neoplasms. Most intestinal lipomas are asymptomatic. However, they may present with bleeding, obstruction, intussusception, or abdominal pain. Spontaneous expulsion of an intestinal lipoma is extremely rare and has never been reported in the postoperative period.

Case Description: We present the case of a 53-year-old male patient who underwent laparoscopic roux-en-Y gastric bypass. On postoperative day 4, the patient had a myocardial infarction and persistent abdominal discomfort. The spontaneous expulsion of an intestinal lipoma was observed on postoperative day 5, after which the patient instantly felt relief. In this case report, we provide a comprehensive literature review of intestinal lipomas, with their complications and management.

Discussion: Only a few spontaneous expulsions of intestinal lipomas have been described in the literature. This is the first reported case of a spontaneous expulsion in the immediate postoperative period or after a myocardial infarction. Intestinal lipomas may cause a variety of complications, including bleeding, obstruction, and intussusception. The likelihood of complications increases with size. The criteria for resection remain controversial, and a variety of technical methods have been described. Spontaneous rectal expulsion of giant intestinal lipomas without surgical or endoscopic manipulation is possible.

Conclusion: Intestinal lipomas are rare and either are asymptomatic or present with unspecific symptoms. A consensus on the clinical management of intestinal lipomas has not been established. Besides open surgery, laparoscopic and endoscopic treatment options are emerging.

Key Words: Lipoma, Laparoscopy, Postoperative complications, Intestinal diseases, Abdominal pain.

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The post Expulsion of Giant Intestinal Lipoma After Laparoscopic Roux-en-Y Gastric Bypass first appeared on JSLS.

Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel (all authors).

ABSTRACT

Although rare, complications can arise during the establishment of pneumoperitoneum during laparoscopic surgery. These include injury to blood vessels, hollow viscera, solid organs, and CO2 embolism.

We report a case of trauma to the liver following the insertion of a Veress needle causing CO2 embolism during laparoscopic adrenalectomy. Opening pressures on insertion were high. Respiratory and cardiovascular changes alerted the anesthesiologists to the possibility of CO2 embolism. The patient was treated with inotropic drugs, placed in Durant’s position, and the operation was aborted. Ultrasound demonstrated gas bubbles within the liver parenchyma and the heart chambers. The patient was transferred to the surgical intensive care unit where she experienced a grand mal seizure. She was later taken to a nearby hospital for hyperbaric oxygen therapy during which she suffered 3 additional seizures. She had subsequent resolution of all neurological symptoms.

The first entry into the peritoneum deserves the full attention of the operating room team, because this is when most CO2 embolisms occur. The team should be prepared to take immediate action on suspicion of embolism. Gas embolism can occur not only by direct cannulation of blood vessels, but also by injury to solid organs, especially the liver. All overweight patients should be suspected of having hepatomegaly and the location of initial entry into the peritoneum should shift accordingly. In selected patients, one should use a direct visualization approach, because this approach has fewer complications and they are more readily identified.

Key Words: Adrenalectomy, Carbon dioxide, Embolism, Laparoscopy, Liver.

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The post Carbon Dioxide Embolism Following Veress Needle Insertion Into the Liver During Laparoscopic Adrenalectomy first appeared on JSLS.

Department of Pediatric and Adolescent Surgery (Drs Castellani, Singer, Friedmacher, Till), Department of Pathology (Dr Ratschek), Department of Radiology (Dr Sorantin), Medical University Graz, Graz, Austria.

ABSTRACT

Introduction: Adrenal cysts are rare findings, with an age peak between the third and fifth decades of life. In adults, laparoscopic and retroperitoneoscopic approaches to these cysts have been described. In pediatric patients, however, reports of this pathology and its management are limited to a small number of case reports.

Case Report: A cystic mass was discovered in the left upper abdominal quadrant of a 12-year-old female patient during the diagnostic workup because of chronic back pain. Blood chemistry, parasitology, and tumor markers were negative, and the patient was scheduled for laparoscopy. Intraoperatively, the cyst was found to originate from the left adrenal gland. Firm attachments between the cyst and the adrenal gland required partial adrenalectomy. The operation and the postoperative course were uneventful, and the patient was discharged on the sixth postoperative day. The histologic workup revealed a true endothelial cyst of the adrenal gland.

Discussion: In the described case, laparoscopy was found to be a safe and feasible approach allowing definitive localization of the pathology and therapy within the same session.

Key Words: Laparoscopy, Adrenal cyst, Children, Abdominal cyst

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The post Laparoscopic Approach to a Unilateral Adrenal Cyst in a Pediatric Patient first appeared on JSLS.

OB/GYN Hospitalist, Department of Obstetrics & Gynecology, Northwest Community Hospital, Arlington Heights, IL, USA (Dr. Markuly). Director, Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA and Director, AAGL/SRS Fellowship in Minimally Invasive Gynecologic Surgery, Advocate Lutheran General Hospital, USA (Dr. Miller). Undergraduate, Northwestern University, Evanston, IL, USA (Szela).

ABSTRACT

Introduction: Uterine rupture is an acute obstetric emergency requiring a rapid response by a multidisciplinary team of physicians and allied health care professionals to minimize the risk of both maternal and neonatal morbidity and death. A risk factor is previous myomectomy. Robotic-assisted laparoscopic myomectomy is a technologically cutting-edge approach to a common surgical procedure, myomectomy. Pregnancy after robotic-assisted laparoscopic myomectomy has been reported in the literature.

Case Description: We report a case of spontaneous uterine rupture in a subsequent pregnancy after robotic-assisted laparoscopic myomectomy.

Discussion: With use of robotic assistance, the technique changes when compared with standard laparoscopic myomectomy. Areas of potential concern are the amount and type of energy required to excise the fibroid from the myometrial bed.

Key Words: Myomectomy, Uterine Rupture, Robotic Surgery, Laparoscopy, Spontaneous, Pregnancy.

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The post Uterine Rupture After Robotic-Assisted Laparoscopic Myomectomy first appeared on JSLS.

Department of Surgery, Mackay Memorial Hospital and Mackay Medical College, Taipei, Taiwan (Drs Wang, Ho, Wei, Cheng, and Liu); Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan (Drs Cheng and Liu).

ABSTRACT

Obturator hernias are rare, and most cases present as incarcerated hernias. They can be repaired either transabdominally or extraperitoneally, by the conventional open method or a laparoscopic approach. We report our technique of transabdominal laparoscopic direct repair using a running barbed suture in 2 cases. Old age and bowel distention are not contraindications to laparoscopic repair.

Key Words: Barbed suture, Laparoscopy, Obturator hernia.

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The post Laparoscopic Repair of Obturator Hernia first appeared on JSLS.

Department of Digestive and Metabolic Surgery, Jean Verdier Hospital, Paris XIII University-University Hospitals of Paris Seine Saint-Denis, Paris, France (Dr. Carandina). Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium (Drs. Mathonet, Cadière).

ABSTRACT

Background: Brunner’s gland hamartoma (BGH) is a rare, proliferative entity arising from alkaline-secreting glands located mainly in the duodenum. In most cases, BGH develops as a polypoid pedunculated lesion of 1 to 2 cm in diameter, whereas in a few cases, the so-called “giant BGH” can reach 12 cm in size. Removal of BGH is required in symptomatic patients, and treatment options include the endoscopic or surgical approach.

Case Report: We report the case of a 33-year-old woman affected by a symptomatic giant BGH. Laparoscopic local surgery was planned. With the patient under general anesthesia, a laparoscopic Kocher maneuver and a polypectomy via duodenectomy were performed. Then the duodenotomy was closed with a horizontal manual suture. The operative time was 75 minutes and blood loss was 40 mL.

Results: The patient made an uneventful recovery and is well at a one-year follow-up. Pathologic examination results showed a 10 2.5-cm BGH without signs of malignancy or dysplasia.

Conclusion: Laparoscopic transduodenal resection can be considered a safe and feasible procedure for large polyps that are not candidates for endoscopic resection.

Key Words: Brunner’s gland hamartoma, Duodenal polyp, Laparoscopy, Excision.

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The post Laparoscopic Resection of Duodenal Giant Brunner’s Gland Hamartoma first appeared on JSLS.