Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA (Dr. Kim)
Department of Surgery, Hackensack Meridian Health JFK Medical Center, Edison, New Jersey, USA (Dr. Bryczkowski)
Department of Surgery, Hackensack University Medical Center, Hackensack, New Jersey, USA (Drs Pereira, Rosenstock, Zumba, Mazpule)
Department of Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA (Dr. Zheng)

ABSTRACT

Introduction: Colonic gastrointestinal stromal tumors are rare and never have been reported to present as diverticulitis.

Case Description: We describe a case of a 63-year-old female who was treated for a perforated sigmoid diverticulitis which was secondary to a gastrointestinal stromal tumor.

Conclusion: While most major guidelines suggest treatment with adjuvant imatinib for immediate or high risk gastrointestinal stromal tumors, there are discrepancies among the guidelines on the management of perforated tumors which warrant further studies to manage these patients.

Key Words: Gastrointestinal stromal tumor; Perforated GIST; Perforated diverticulitis.

The post Gastrointestinal Stromal Tumor Presenting as Perforated Diverticulitis 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.

Chirurgie Digestive A, Département de Chirurgie Digestive, Hôpital Universitaire de St Eloi, Université de Montpellier, Montpellier, France (both authors).

ABSTRACT

Background: Esophageal submucosal gastrointestinal stromal tumors (GISTs) are rare. Resection is indicated due to their malignant potential.

Case Description: A 76-year-old woman complained of mild dysphagia. A submucosal tumor of the lower thoracic esophagus was found endoscopically. Computed tomography (CT) scan revealed a 40-mm anterolateral submucosal tumor. Endoscopic ultrasound revealed a hypoechoic and inhomogeneous lesion, developed from the fourth layer of the lower esophagus. In the prone position, the patient underwent robot-assisted right thoracoscopic enucleation of the esophageal submucosal tumor. The procedure was successfully completed with three trocars. No surgical complications occurred during the intervention or the postoperative stay. The patient was discharged on postoperative. Pathologic examination of the specimen revealed a GIST.

Conclusion: To the best of our knowledge, this is the first report of esophageal submucosal GIST enucleation with a patient in the prone position using robotic surgery platform. This approach, which complements the prone position by allowing amore precise dissection, is particularly appropriate for submucosal tumor enucleation and needs to be further evaluated.

Key Words: esophageal submucosal tumor, enucleation, robotic surgery, prone position, gastrointestinal stromal tumor.

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The post Robotic Enucleation of an Esophageal Submucosal Tumor in the Prone Position first appeared on JSLS.

Department of Surgery, Hackensack University Medical Center, Hackensack, NJ, USA (Drs. Tiesi, Eid). Department of Surgical Oncology, Hackensack University Medical Center, Hackensack, NJ, USA (Dr. McCain).

ABSTRACT

Introduction: Despite evolving experience with laparoscopic resections of gastric gastrointestinal stromal tumors (GISTs), there are few data describing robotic resections. Here we describe the robotic removal of a gastric GIST using laparoscopic ultrasonography for tumor localization.

Case Description: The patient is a 46-year-old African-American man with a biopsy-proven 3.5 X 3.5-cm GIST along the greater curvature of the stomach, and with no evidence of metastatic disease on preoperative computed tomographic staging. Three robotic ports (12-mm umbilical, 8-mm left lower quadrant, and 8-mm subxiphoid) were combined with a 12-mm right lower quadrant assist port and a right midabdomen 8-mm port for the laparoscopic liver retractor. Mass localization was facilitated by intraoperative ultrasonography and dissection performed with bipolar electrocautery via dissecting forceps. Resection was performed using a stapled technique and the specimen removed via the assist port. Total operative time was 104 minutes and estimated blood loss was 25 mL. There was no significant morbidity. Length of stay was 3 days, and the patient returned to work within 1 week. The retrieved specimen was CD117- and DOG1-positive with 2 to 3 mitoses/hpf. At 1-year follow-up, there was no evidence of disease.

Discussion: This case report describes a novel and efficient technique for the robotic removal of a gastric GIST. This resection can be safely performed with the aid of intraoperative ultrasonography instead of gastroscopy or gastrotomy for identification of resection margins.

Key Words: Gastrointestinal stromal tumor, Robotics, Laparoscopic ultrasonography.

The post Ultrasound-Guided, Robotic Gastrointestinal Stromal Tumor Resection first appeared on JSLS.