Division of General Surgery and Bariatric Center of Excellence, Department of Medicosurgical Sciences and Biotechnology, La Sapienza University of Rome, Latina, Italy (all authors).

ABSTRACT

Introduction: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective procedure for losing weight and gaining control of obesity-related comorbidities. However, it is associated with postoperative complications such as bleeding, leak, and midgastric stenosis. Splenic and hepatic abscesses have been reported as unusual and rare complications after primary LSG. We report a case of splenic and concomitant hepatic abscesses after primary LSG, successful minimally invasive management, and midterm follow-up.

Case Description: We report a complex case of splenic abscess with satellite hepatic abscess plus splenic thrombosis (0.1%) diagnosed 67 days after LSG. This unusual complication was managed by a minimally invasive approach (spleen sparing) with complete resolution after 35 days. After 18 months of follow-up, the patient showed complete resolution of the splenic and liver abscesses and progressive loss of excess weight.

Conclusion: TIn high-volume centers, rare and life-threatening complications such as splenic and hepatic abscesses may be observed. The minimally invasive approach could represent an effective option of avoiding splenectomy in selected cases.

Key Words: Splenic and hepatic abscess, Sleeve gastrectomy, Complications, Thrombosis.

The post Splenic and Concomitant Liver Abscess After Laparoscopic Sleeve Gastrectomy first appeared on JSLS.

Department of Surgery, McGovern Medical School at UT Health, Houston, Texas, USA (all authors).
Michael E. Debakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, Texas, USA (Dr. Shah).

ABSTRACT

Introduction: Long-term outcomes of laparoscopic adjustable gastric band (LAGB) placement have shown suboptimal excess weight loss and higher than expected device-related complications.

Case Description: We report a 45-year-old woman in whom the adjustable gastric band tubing eroded into the stomach, causing a port-site infection.

Conclusion: Because of the number of LAGB procedures performed previously and the incidence of band-related complications, surgeons must be able to recognize and manage these complications. Erosion of the gastric band or the connection tubing or both should be included in the differential diagnosis for patients presenting with a port-site infection.

Key Words: Complications, Erosion, Gastric band.

The post Erosion of Gastric Band Tubing Presenting as Port-Site Cellulitis first appeared on JSLS.

Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA (Dr. Pereira). Division of Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA, USA (Drs. Grias, Della Badia).

ABSTRACT

Introduction: Perforation of the uterus or fallopian tube during microinsert placement, with subsequent migration of the microinsert into the abdominopelvic cavity, is a known complication.

Case Description: A 38-year-old woman underwent hysteroscopic tubal sterilization with Essure microinserts (Conceptus, Mountain View, California). She returned 4 months later for hysterosalpingography, during which only part of the right microinsert was identified in the right cornu of the uterus. The remaining part of the microinsert was suspected to be in the pelvic cavity. Laparoscopy showed one fragment of the right microinsert projecting from the right cornu; the remaining fragment was incorporated into the serosa of the distal ileum. After an intraoperative consultation with the colorectal surgery team, both fragments of the microinsert were left as is, and tubal fulguration for sterilization was performed.

Discussion: Although perforated microinserts can cause small-bowel obstruction or perforation, our case highlights the asymptomatic incorporation of a microinsert into the serosa of the distal ileum.

Key Words: Essure, Hysteroscopy, Complications, Small bowel, Migration.

The post Asymptomatic Serosalized Essure Microinsert in the Distal Ileum first appeared on JSLS.

USC Institute of Urology, Center for Advanced Robotic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA (all authors).

ABSTRACT

Introduction: Pelvic lymphoceles are a known complication of pelvic lymph node dissection after robotic-assisted radical prostatectomy (RARP). However, large symptomatic inguinal lymphoceles after RARP have hitherto not been reported.

Case Description: We present the case of a 71-year-old morbidly obese man who developed large, symptomatic, bilateral inguinal lymphoceles after RARP and pelvic lymph node dissection. The surgery itself was uneventful, as was the hospital stay. The patient returned 3 weeks postoperatively with bilateral inguinal pain and swelling, which was confirmed on imaging to be bilateral inguinal lymphoceles. These were initially treated with bilateral percutaneous pigtail catheter drainage, but this treatment was complicated by repeated tube blockages, fever, and conversion of the lymphoceles into multiloculated abscesses. Definitive treatment consisted of open left lymphocele excision first. After excision of the left inguinal lymphocele, the right lymphocele became infected and formed a large inflammatory phlegmon, necessitating open right inguinal lymphocele excision with right orchiectomy. Culture demonstrated gram-negative Prevotella bivia.

Discussion: This case was unique because the patient presented with bilateral, large, symptomatic, recurrent inguinal lymphoceles, as opposed to the more common pelvic lymphoceles. To our knowledge, this is the first reported case of bilateral, symptomatic inguinal lymphoceles after RARP with pelvic lymph node dissection.

Key Words: Lymphocele, Radical prostatectomy, Robotics, Complications.

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The post Bilateral Inguinal Lymphoceles Following Robotic Radical Prostatectomy first appeared on JSLS.

Department of Gynecology and Obstetrics, School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil (all authors).

ABSTRACT

Hysteroscopic myomectomy is the surgical procedure of choice for the treatment of submucous or intramural myomas that protrude into the uterine cavity in patients with abnormal bleeding and/or infertility. It is a minimally invasive procedure associated with a low complication rate. Complications of hysteroscopy include uterine perforation, intraoperative and postoperative uterine bleeding, water intoxication, gas embolism, and injuries of the bladder, ureters, and major blood vessels, in addition to late complications, such as infections and synechiae. This case report describes iliac artery injury during hysteroscopic myomectomy. A review of the literature shows that this complication has not been recorded.

Key Words: Hysteroscopy, Myomectomy, Complications, Iliac artery injury

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The post Iliac Artery Lesion as a Severe Complication of Hysteroscopic Myomectomy first appeared on JSLS.