Department of Surgery, New York Methodist Hospital, Brooklyn, New York, USA (all authors).

ABSTRACT

Introduction: Port site metastases are known phenomena associated with laparoscopic resection of intra-abdominal malignancies, but have not been well documented for gastric cancer. We report a case of port site metastases after laparoscopic subtotal gastrectomy for advanced gastric adenocarcinoma.

Case Description: A 71-year-old woman with a history of hypertension and diabetes mellitus presented with melena, weight loss, and signs of gastric outlet obstruction. Preoperative workup demonstrated a T3N1M0 mass extending along the lesser curvature of the stomach with biopsy confirming adenocarcinoma. The patient underwent an uneventful laparoscopic subtotal gastrectomy with D2 lymphadenectomy followed by adjuvant chemotherapy. Thirteen months after surgery, the patient presented with palpable subcutaneous nodules at two of the port sites. computed tomographic (CT) scan confirmed the isolated nodules without distant metastases and fine-needle aspirations confirmed gastric adenocar- cinoma. The patient was treated with another cycle of chemotherapy. A post treatment proton emission tomography (PET) scan did not show any other lesions, and the patient was scheduled for resection. During surgery the left upper quadrant mass was found to infiltrate the left colon and an additional mass was found at the prior umbilical port. Pathology was consistent with gastric adenocarcinoma for all the lesions. An excisional biopsy of the right upper quadrant lesion was completed.

Conclusion: Given the rarity of port site metastases after gastric adenocarcinoma, there is no conclusive literature regarding the management. Repeat chemotherapy followed by resection, if feasible, appears to be the most reasonable therapeutic intervention if there is no evidence of distant metastases.

Key Words: Chemotherapy, Gastric adenocarcinoma, Laparoscopic gastrectomy, Port site metastasis.

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The post Multiple Port Site Metastases After Laparoscopic Gastrectomy for Cancer first appeared on JSLS.

Department of Surgery, University of Texas Medical School, Houston, TX (all authors). Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX (Dr Shah).

ABSTRACT

Introduction: With the decreasing popularity of adjustable gastric band (AGB) placement and the increase in explants of the devices, for erosion, slips, or inadequate weight loss, in performing revisional surgery, it is of vital importance for surgeons to understand the problems that may arise during removal. This case involved an uncommonly reported complication of fractured band tubing resulting in incomplete removal of the tubing during revisional bariatric surgery, with reoperation necessary for complete removal. In the course of the procedure, a small-bowel tumor was identified.

Case Description: We present a 35-year-old woman who underwent conversion of a laparoscopic AGB to a sleeve gastrectomy. Failure to recognize a fracture in the band tubing resulted in retained tubing and readmission secondary to abdominal pain. During reoperation to remove the retained tubing, a small-bowel gastrointestinal stromal tumor (GIST) was incidentally identified and resected.

Discussion: This case highlights a rarely reported complication of fractured gastric band tubing, resulting in incomplete removal of the tubing during revisional surgery, with the incidental discovery of a GIST in the small bowel.

Key Words: Adjustable gastric band, Gastrointestinal stromal tumor, Re-operative surgery, Revisional bariatric surgery.

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The post Words of Caution Regarding Adjustable Gastric Band Tubing first appeared on JSLS.

Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA (Dr. Stemmer). Virtua Hospital, Voorhees, NJ, USA (Dr. Stemmer). Genesis Biotechnology Group, Medical Diagnostic Laboratories LLC, Hamilton, NJ, USA (Dr. Shurshalina).

ABSTRACT

Introduction: There has been a scarcity of cases of isolated fallopian tubes torsion in the literature.

Case Description: Isolated fallopian tube torsion in a 27-year-old woman was associated with a hydrosalpinx. Laparoscopic detorsion of the right fallopian tube was performed within 24 hours of the onset of clinical symptoms. Surgical management was based on evaluation of tubal status and visual restoration of local perfusion as evidenced by the pink color of the untwisted tube and tested patency.

Discussion: Conservative surgical management to maximize fertility preservation should be the goal of treatment of women of reproductive age. Successful salvaging of tubal integrity rests on a low threshold for surgical management, the time from onset of symptoms to detorsion, the degree of tissue damage due to ischemia, and predisposing factors for tubal torsion.

Key Words: Tubal torsion, Hydrosalpinx, Laparoscopy.

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The post Isolated Fallopian Tube Torsion: Detorsion and Tubal Preservation first appeared on JSLS.

Department of Surgery, Hurley Medical Center, Michigan State University, Flint, Michigan, USA (Dr Wilson). Department of Surgery, Morehouse School of Medicine, Atlanta, Georgia, USA (Drs Bowman, Matthews, Danner). Department of Surgery, Florida Celebration Hospital, Celebration Florida, USA (Dr Rosser).

ABSTRACT

Background: A traumatic diaphragm rupture presents a unique obstacle to a minimally invasive surgical approach; most repairs are performed during an emergency laparotomy. Diaphragm injuries are diagnosed in the acute phase of blunt-force trauma in only 10% of cases, and a high index of suspicion must be maintained to avoid strangulation of the abdominal organs that have herniated into the thoracic cavity. A laparoscopic evaluation and repair of an acute blunt-force rupture of the diaphragm can be diagnostic and curative, mimicking the outcome of an open procedure.

Case Description: A 23-year-old woman had a left-side blunt-force rupture of the diaphragm sustained in a high-impact motor vehicle collision. The focused assessment with sonography for trauma (FAST) was negative. The survey chest radiograph identified only streaky opacities that were read as atelectasis. Computed tomography of the abdomen revealed the presence of a congenital abnormality versus a ruptured diaphragm. A diagnostic trauma laparoscopy was performed to evaluate for the possibility of a left-side rupture, and at that point, the spleen and the stomach were found to be located in the left chest, herniating through a rupture in the left diaphragm. A grade I splenic laceration was present. The abdominal structures were reduced and the traumatic rupture was successfully repaired laparoscopically.

Discussion: Traumatic rupture of the left diaphragm can occur as an occult injury after blunt-force trauma to the torso. The liver lends protection to the diaphragm and a right-side rupture is far less common than one on the left side. The initial diagnostic plain chest x-ray may not reveal the tear in the diaphragm and the herniation of abdominal viscera into the thoracic cavity. Laparoscopy has been used to evaluate the possibility of a rent in the diaphragm when the patient is hemodynamically stable and the diagnosis is uncertain. Although initial laparoscopic or thorascopic evaluation of a potential rupture of the diaphragm is the standard of care in the trauma literature, laparoscopic repair is not widely accepted. However, laparoscopic evaluation of acute torso trauma with reduction of abdominal viscera and subsequent laparoscopic repair of the diaphragm can be successful.

Key Words: Blunt abdominal trauma, Laparoscopic diaphragmatic hernia repair, Ruptured diaphragm.

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The post Laparoscopic Repair of a Ruptured Diaphragm: Avoiding a Trauma Laparotomy first appeared on JSLS.

Mount Sinai–Roosevelt Hospital, New York, NY, USA.

ABSTRACT

Introduction: The occurrence of pelvic organ fistulas, after extensive pelvic surgery, has been widely described in the literature, as well as their surgical management via abdominal, vaginal, and laparoscopic approaches. Treatment depends on their etiology and location, as well as the surgeon’s experience.

Case Description: We present the case of a coloperitoneal-colovaginal fistula, a unique clinical scenario. This developed as a complication of robotic-assisted laparoscopic resection of a pelvic mass, treatment of endometriosis, and trachelectomy. A conservative approach was used to treat the patient via interventional radiology-assisted drainage.

Discussion: Successful conservative management of a complex fistula between the colon, peritoneum, and vagina is feasible.

Key Words: Coloperitoneal fistula, Colovaginal fistula, Conservative management, Interventional radiology-assisted drainage.

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The post Conservative Management of Coloperitoneal-Vaginal Fistula first appeared on JSLS.

Department of Surgery, University of Texas Medical School at Houston, Houston, TX, USA (Drs. Starnes, Mehta, Shah, Bajwa, Wilson, Walker). Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA (Dr. Shah).

ABSTRACT

Introduction: Complications due to retained gastric band tubing are rarely reported and frequently include disconnections of the tubing requiring operative revision. Obstruction from adjustable gastric band tubing is an infrequently reported event.

Case Description: The patient presented to us 1 month after removal of a presumed isolated infected port performed at an outside facility. The wound was left open, but the intra-abdominal tubing and band were left in place. Abdominal distention, pain, and peritonitis developed, and the patient was taken to the operating room because of concern regarding an acute intra-abdominal process. Intraoperatively, he was noted to have a sigmoid obstruction from the retained gastric band tubing.

Discussion: Although obstruction from adjustable gastric band tubing is infrequently reported in the literature, it poses a potentially devastating complication. We review the relevant literature and potential issues when dealing with band-related tubing.

Key Words: Internal hernia, Adjustable gastric band, Bowel obstruction, Port infection.

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The post Retained Gastric Band Tubing Resulting in Large Bowel Obstruction first appeared on JSLS.

Wayne State University, Detroit, MI, USA (all authors).

ABSTRACT

Mesenteric fibromatosis poses a diagnostic and therapeutic challenge. We report a case of giant cell mesenteric fibromatosis tumor arising from the mesentery of the small intestine in a patient two years after a Roux-en-Y gastric bypass. A 47-year-old African-American female presented as a transfer from an outside institution with a large abdominal mass that was initially diagnosed as an intraabdominal cyst on computed tomography scan. The tumor was successfully excised surgically and the diagnosis of mesenteric fibromatosis tumor was confirmed on immunohistochemical analysis. To our knowledge, this is the only reported case of mesenteric fibromatosis tumor arising from the jejunojejunostomy anastomosis of the small bowel mesentery after Roux-en-Y gastric bypass surgery to treat morbid obesity.

Key Words: Mesenteric fibromatosis, Small bowel mesentery, Gastric bypass.

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The post Mesenteric Fibromatosis of the Small Bowel Mesentery After Gastric Bypass Surgery first appeared on JSLS.

Department of Surgery, Westchester Medical Center, Valhalla, NY, USA (Dr. Alemayehu). Department of Pediatric Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY (Drs. Pandya, McBride, Stringel).

ABSTRACT

Introduction: Thoracoscopic repair of congenital diaphragmatic hernia has increased with the use of prosthetic material. When the defect cannot be repaired primarily, a variety of materials have been used. The ideal prosthetic material has not been identified yet. The use of biologic tissue matrix prosthesis is appealing because this material may serve as a framework to support the patient’s own tissue regeneration. We report on 2 newborns with congenital diaphragmatic hernia repaired by thoracoscopy with placement of a Strattice patch (LifeCell, Branchburg, New Jersey). The hernia recurred in both cases.

Case Description: Two neonates born at term, weighing 3.5 kg and 4.0 kg, had left-sided congenital diaphragmatic hernias repaired by thoracoscopy with a Strattice patch. The repairs were performed at 1 and 4 days of age after a period of stabilization. There were no other congenital anomalies. There were no operative complications. The neonates recovered uneventfully and were discharged in good condition. Recurrence of the diaphragmatic hernia was identified by chest radiographs at routine follow-up visits 16 and 22 months postoperatively. One patient had mild abdominal pain and increasing shortness of breath, whereas the other patient was asymptomatic. One patient had an abdominal open primary repair of the recurrent diaphragmatic hernia, whereas the other patient had a laparoscopy-assisted repair with AlloDerm patch (LifeCell). They both recovered uneventfully.

Discussion: Postoperative follow-up at regular intervals is extremely important after repair of diaphragmatic hernia, especially when prosthetic material is used, because of the high incidence of recurrence. We do not recommend the repair of diaphragmatic hernia with the Strattice patch at this time.

Key Words: Congenital diaphragmatic hernia repair, Thoracoscopy, Strattice mesh

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The post Recurrence of Diaphragmatic Hernia After Thoracoscopic Repair With Strattice Patch first appeared on JSLS.