Department of Surgery, Monmouth Medical Center, Long Branch, New Jersey (Drs. Mackowsky and Borao).
Department of Surgery, Hackensack University Medical Center, Hackensack, New Jersey (Drs. Hadjiloucas and Lira).

ABSTRACT

Background: Concurrent laparoscopic paraesophageal repair with colectomy has yet to be described in the literature.

Case Description: An 88-y-old male with shortness of breath and rectal bleeding presented to the emergency depart- ment. Workup ultimately revealed a nonobstructing ascending colon mass within the sac of type IV paraesophageal hernia. The decision was made to proceed with laparoscopic colectomy with concurrent paraesophageal hernia repair.

Conclusion: To reduce overall operative time and optimize recovery, the decision was made to perform both operations synchronously. The patient suffered no intraoperative or postoperative complications and experienced a full and timely recovery. To the best of our knowledge, simultaneous colon resection with paraesophageal hernia repair has not been described in the literature. Despite the inherent high risk, performing both procedures in a single operation helped to decrease the patient’s anesthesia time and overall recovery time as well as risks of reoperation.

Key Words: paraesophageal hernia repair, colectomy, adenocarcinoma.

The post Simultaneous Repair of Paraesophageal Hernia and Colectomy for Colon Cancer first appeared on JSLS.

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, 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.