Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA (both authors).

ABSTRACT

Introduction: Enterogenous cysts of the pancreas are rare congenital foregut cysts. The natural history of these entities is still relatively unknown, as is their propensity for malignant transformation. Thus, optimal management is still undetermined.

Case Description: A 39-year-old African American woman underwent a computed tomography scan of the chest that showed an incidental cystic lesion of the pancreas. Endoscopic ultrasonography–guided fine-needle aspiration (FNA) identified an elevated carcinoembryonic antigen level, as well as benign, focally ciliated columnar cells, histiocytes, and proteinaceous material, with no evidence of malignant transformation. These findings were consistent with respiratory or bronchial versus dermoid or endometrial (müllerian) origin. A laparoscopic distal pancreatectomy was performed, and the final pathologic findings showed gastric tissue surrounded by a rim of normal pancreatic tissue, consistent with a benign enterogenous cyst. The patient recovered well.

Discussion: Enterogenous cysts that arise outside of the liver are exceedingly rare and represent both a diagnostic and therapeutic challenge. On imaging, they can be mistaken for malignant cystic lesions. Pathologic examination provides definitive identification, with FNA smears giving pathognomonic characteristics; however, FNA samples can miss the architecture of the cyst. Moreover, there is limited knowledge of the natural history of these lesions, and reports exist of other enterogenous or developmental abnormalities undergoing malignant transformation. Although it would be preferential to avoid unnecessary surgery for these rare lesions, not enough is known about their behavior. Surgery remains the standard of care and the more “conservative” management option for these cystic lesions of the pancreas.

Key Words: Enterogenous cyst, Pancreas, Laparoscopic distal pancreatectomy

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The post Incidental Enterogenous Cyst of the Pancreas: Resection or Observation? first appeared on JSLS.

Center for Specialized Surgery, Florida Hospital, Orlando, Florida (all authors).

ABSTRACT

Introduction: Hernias anterior to the sternum have rarely been reported and usually occur in the context of abdominal trauma. The literature reports hernia as a complication of omental flap reconstruction, but as yet there is little information on the laparoscopic repair of large subxiphoid hernia resulting from omental flap reconstruction.

Case: A 52-year-old woman presented 2 years after surgery with a large subxiphoid hernia containing the transverse colon. She had a history of metastatic follicular dendritic cell sarcoma after right lung lobectomy that led to infectious mediastinitis and a nonhealing sternal wound, for which she underwent omental flap repair.

Discussion: Our findings show the omentum can be reliably utilized to reconstruct thoracic defects. It can be a dependable salvage flap for previously failed reconstructions and can be transected in the face of a laparoscopic repair of a subxiphoid hernia. Furthermore, minimally invasive laparoscopic surgery provides a safe and effective surgical approach in a complicated patient with a subxiphoid hernia.

Key Words: Anterior wall reconstruction, Minimally invasive hernia repair, Omental flap, Subxiphoid hernia

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The post Laparoscopic Repair of a Subxiphoid Hernia After Omental Flap Reconstruction first appeared on JSLS.

Department of Hepato-pancreato-biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia (Drs. Efanov, Alikhanov, Kazakov, Melekhina, Kim, and Vankovich and Prof. Cvirkun). Moscow Clinical Scientific Center, Moscow, Russia (Prof. Khatkov).

ABSTRACT

Introduction: Radical surgery is the only curative method for liver alveolar echinococcosis (AE). To date, there is no information about the efficacy of laparoscopy including robot-assisted liver resection in radical treatment of AE. This is a case report of a robot-assisted radical liver resection for AE.

Case Description: A 51-year-old man was admitted to the clinic with complaints of weakness and pain in the right abdomen. Computed tomography (CT) revealed a lesion measuring 46 52 86 mm, located in liver segments VI and VII, and robot-assisted resection of those segments was performed. The surgery lasted for 485 minutes, and intraoperative blood loss was 1000 mL. The position of the patient, sites of trocars placement, and details of the surgery are described. The patient had an uneventful postoperative course and was discharged on day 10. Albendazole, was administered for 2 years as antiparasitic chemotherapy. Dynamic monitoring for more than 13 months showed no recurrence of the disease.

Discussion: Publications on the use of laparoscopic and robotic resection of posterior liver segments are scarce, but experience has shown that the learning curve for the use of the robotic system is shortened in comparison with that for other approaches. After the case reported herein, we have performed similar procedures and have seen a marked decrease in blood loss and operative time. This case and our growing experience in performing radical robot-assisted liver resections demonstrate the feasibility of using robotic laparoscopic approaches for radical treatment of early diagnosed liver AE, particularly when the affected liver segment is difficult to reach.

Key Words: Alveolar echinococcosis, Hepatectomy, Liver resection, Radical treatment, Robotic surgical procedures

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The post Radical Robot-Assisted Liver Resection for Alveolar Echinococcosis first appeared on JSLS.

Department of Obstetrics and Gynecology, University of Central Florida College of Medicine, Orlando, Florida (both authors).

ABSTRACT

Introduction: An ovarian artery pseudoaneurysm is a rare disorder of pregnancy.

Case Description: We present a case of an unruptured ovarian artery pseudoaneurysm during the first trimester, managed laparoscopically. The patient had undergone a previous right salpingo-oophorectomy and presented several weeks later with severe right adnexal pain. Doppler sonography and magnetic resonance arteriography revealed a right ovarian artery pseudoaneurysm. The patient declined selective embolization. Laparoscopic ligation of the pseudoaneurysm resulted in resolution of her symptoms. A complete description of the case, radiologic imaging, and a review of the literature are provided.

Discussion: Laparoscopy is an option for treating unruptured pelvic pseudoaneurysms during early pregnancy.

Key Words: Aneurysm, Laparoscopy, Ovarian artery, Pregnancy, Pseudoaneurysm

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The post Laparoscopic Ligation of a First-Trimester Ovarian Artery Pseudoaneurysm first appeared on JSLS.