Department of Biliary Surgery, Shengjing Hospital of China Medical University, Shenyang City, People’s Republic of China (both authors).

ABSTRACT

Introduction: Symptomatic Meckel’s diverticulum during pregnancy and inverted Meckel’s (“ windsock ”) divertic- ulum are rare occurrences. Preoperative diagnosis is difficult, and inverted diverticulum can be misdiagnosed as lipoma.

Case Description: We report a case of Meckel’s diverticulum during pregnancy, causing a hernia of the small intestine, and a case of inverted Meckel’s diverticulum causing an ileocolic intussusception.

Discussion: When dealing with small-bowel obstruction of unknown origin, Meckel’s diverticulum is a cause that is easy to miss. Early laparoscopic exploration helps as an auxiliary diagnostic tool and can avoid small-bowl necrosis or intestinal perforation caused by long-standing small bowel obstruction.

Key Words: Bowel malformation, Laparoscopic surgery, Meckel’s diverticulum, Pregnancy.

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Department of Urology, Jan Biziel Medical University Hospital, Bydgoszcz, Poland (Drs Jarzemski P, Listopadzki, and Jarzemski M).

Department of Urology, Medical University of Gdańsk, Gdańsk, Poland (Drs Markuszewski and Roslan).

ABSTRACT

Background and Objectives: Minimally invasive techniques have been introduced to decrease the morbidity related to standard laparoscopic procedures. One such approach is transvesical laparoendoscopic single-site surgery (T-LESS). We describe our clinical experience of using this technique for vesicorectal fistula (VRF) repair.

Description: In October 2013, we performed the T-LESS repair of a vesicorectal fistula of 5 mm diameter in a 72-year-old man, in whom conservative treatment with temporary colostomy and Foley catheter placement had failed. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device via a 15 mm incision made 20 mm above the pubic symphysis. Standard 10 mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and closed in two layers with a running, absorbable, barbed suture. A cystostomy tube was left in place for 22 days, and a Foley catheter for 1 week.

Results: The operation lasted 155 min. Blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 5-week follow-up, the patient reported no involuntary discharge of urine into the rectum. A voiding cystourethrogram revealed no presence of VRF, and laboratory examination results were all within the normal range. The colostomy was closed after 4 months, and a 12-month follow-up confirmed the integrity of both the urinary and digestive tracts.

Conclusion: Although substantial development of the instruments and skills is needed, the T-LESS VRF repair appears to be feasible and safe. Nevertheless, further experience and observations are necessary.

Key Words: Laparoscopic surgery, Prostate cancer, Vesicorectal fistula.

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Department of Surgery, University of Texas Medical School at Houston, Houston, Texas, USA (Drs. Ikoma and Shah); Keio University, School of Medicine, Tokyo, Japan (Drs. Ikoma, Itano, Oshima, and Kitagawa); Department of Surgery, Eiju General Hospital, Tokyo, Japan (Drs. Ikoma, Itano, and Oshima); Department of Surgery, Beth Israel Medical Center, New York, New York, USA (Dr. Fukuhara); Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, Texas, USA (Dr. Shah).

ABSTRACT

Hepatic malignancies are frequently associated with primary liver disease, including hepatitis and cirrhosis. It is not uncommon for selected patients to require repeated operations for tumor recurrence. Subsequent operations are more challenging because of dense adhesions from prior operations combined with the inherent risk for liver dysfunction. We present the case of a 64-year-old man with a 20-year history of hepatitis B who developed recurrent hepatocellular carcinoma and underwent repeated laparoscopic hepatectomies on 4 separate occasions. We found that the laparoscopic approach in repeat hepatectomy offers significant advantages, including minimal adhesions, superior visualization, and favorable effect by generated by pneumoperitoneum. Laparoscopic hepatectomy will potentially become a standard strategy for the treatment of liver malignancies associated with background liver abnormalities, which carry the high possibility of reemergence of the liver malignancy in the remnant of the liver.

Key Words: Laparoscopic surgery, Hepatectomy, HCC, Hepatitis.

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Department of Surgery, Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan (all authors).

ABSTRACT

Introduction: Portomesenteric venous thrombosis (PMVT) is a rare and often fatal disease that is difficult to diagnose. The symptoms are nonspecific, and diagnosis and initial treatment tend to be delayed. The initial treatment strategy for PMVT has recently tended toward the use of conservative methods before surgical intervention, and most patients can be successfully treated in this way. In rare cases, however, bowel strictures may develop, owing to chronic ischemia.

Case Description: We present a case of elective laparoscopy-assisted small-bowel resection of ischemic jejunal stenosis following extensive portal, mesenteric, and splenic vein thrombosis.

Discussion: Laparoscopy is indicated for this condition because of the possible need for repeated operations and extensive intraoperative exploration. However, laparoscopy with pneumoperitoneum can be a risk factor for recurrent PMVT, indicating the need to develop methods to shorten the operation time.

Key Words: Delayed bowel strictures, Laparoscopic surgery, Pneumoperitoneum, Portomesenteric venous thrombosis.

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Department of Obstetrics and Gynecology, and Reproductive Sciences, University of California San Francisco, CA (Drs. Ho, Lager). Northern California Chapter of the American College of Surgeons, and Division of General and Trauma Surgery, Marin General Hospital, Larkspur, CA (Dr. Maa). Department of Surgery, Columbia University, New York, NY (Dr. Liou).

ABSTRACT

The female hydrocele, also known as the canal of Nuck cyst, is a rare congenital abnormality that is the equivalent of the patent processus vaginalis in males. We are the first to report the laparoscopic excision of an entirely extraperitoneal canal of Nuck cyst. We discuss the embryology, pathophysiology, and surgical management of this atypical variant of a rare entity.

Key Words: Canal of Nuck cyst, Hydrocele, Laparoscopic surgery, Processus vaginalis.

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Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana (both authors).

ABSTRACT

Intra-abdominal adhesions are a common complication of abdominal surgery and can lead to further complications including bowel obstruction, infertility, and pain. We describe a novel technique of performing transvaginal laparoscopic lysis of adhesions following a total vaginal hysterectomy in a 41-year-old woman with periumbilical pain and menorrhagia. This natural orifice transluminal endoscopic surgical procedure was tolerated well, did not add considerable overall operating time, and did not require extensive additional training. The patient reported no periumbilical pain at 1 year.

Key Words: Surgery-induced tissue adhesions, Laparoscopic surgery, Natural orifice transluminal endoscopic surgery, Hysterectomy, Vaginal

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The post Transvaginal Adhesiolysis Using Laparoscopic Instruments first appeared on CRSLS.

Dekalb Surgical Associates, P.C., Decatur, GA, USA (Dr. Champney). Metropolitan Atlanta OB/GYN, Decatur, GA, USA (Dr. Malloy).

ABSTRACT

We present a case report describing the outcome of an appendectomy and subsequent ovarian cyst enucleation using a single-incision laparoscopic approach in a 19-year-old patient. In an acute care setting, computed tomography of the abdomen demonstrated findings consistent with early acute appendicitis as well as a complex cystic mass on the right ovary. Pelvic ultrasonography revealed a right ovarian cystic lesion measuring 2.9 cm. There were no intraoperative complications. This case report demonstrates the feasibility of single-incision laparoscopy even when separate pathologic results are encountered and is, to our knowledge, the first report of the use of this technique for simultaneous appendectomy and dermoid cyst enucleation.

Key Words: Laparoscopic surgery, Appendectomy, Dermoid cyst.

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Department of Surgery, (Drs. Faraj, Malek, Itani, Mr. El Naaj, Ms. El Nouno, Dr. Khalife), Department of Radiology, (Drs. El Merhi, Haidar), American University of Beirut Medical Center, Beirut, Lebanon.

ABSTRACT

Introduction: The liver is the organ most commonly affected by hydatid disease and is involved in up to 70% of cases. Surgical management can be open or laparoscopic; it can vary from a radical procedure such as hepatic resection or pericystectomy or a more conservative approach such as partial cystectomy. Bile leak after surgery can occur in between 13% and 26% of cases.

Case Description: We present the case of a 47-year-old patient who was diagnosed with 2 large hydatid liver cysts in segments V and VI and segments II and III, respectively. She underwent laparoscopic pericystectomy for both cysts and was discharged 2 days later. She presented after 10 days complaining of abdominal pain and fever. Computed tomography scan of the abdomen showed a 6 7–cm collection at the surgical site of segments II and III. A percutaneous drain was inserted and drained 60 mL of dark bilious fluid. The patient did well after drainage and was discharged home after 6 days.

Discussion: Irrespective of the surgical treatment chosen, bile leaks may complicate any procedure and must always be considered seriously. Although there have been numerous studies concerning bile leak after open surgery, there are only a few describing bile leaks after laparoscopic surgery. Managing bile leaks after hydatid cyst excision is still a matter of debate. Some physicians would advocate conservative management; other physicians would recommend a further procedure such as sphincterotomy or biliary stenting after endoscopic retrograde cholangiopancreatography.

Key Words: Hydatid disease, Open surgery, Laparoscopic surgery, Bile leak.

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ABSTRACT

We herein report a rare case of gastric and regional lymph node metastasis of cutaneous malignant melanoma that underwent curative resection. The patient, a 68-year-old man, was first diagnosed as having cutaneous malignant melanoma of the right forearm in 2005. He had extensive skin excision and axillary lymph node dissection and had undergone adjuvant chemotherapy. Six years after the primary surgery, gastrointestinal endoscopy revealed gastric metastasis of a malignant melanoma. As there was no other metastasis found, laparoscopic-assisted distal gastrectomy with lymph node dissection was performed. Microscopic findings showed diffuse melanin granule growth invading the muscularis propria of the stomach. Micrometastases of the lymph nodes were observed that were not detected by preoperative examination. Seventeen months have passed without recurrence. We conclude that regional lymph node dissection should be performed with gastrectomy whenever distant metastases are not observed, because there is a possibility of micrometastases, which cannot be detected preoperativ

The post Curable Resection in Gastric and Lymph Node Metastases From Melanoma first appeared on CRSLS.

ABSTRACT

Powered laparoscopic staplers have entered the market in the last few years. We report the first case of a malfunction of a powered laparoscopic stapler during a laparoscopic nephrectomy for a nonfunctioning kidney. The complication was salvaged with further laparoscopic maneuvers by the surgeon without conversion or any further intraoperative complication. Powered laparoscopic staplers, like the nonpowered versions, are equally prone to device malfunction despite manual safety override mechanisms. Laparoscopic surgeons using these devices must be aware of this rare complication and possess the necessary skills to troubleshoot and overcome the problem without endangering the patient.

The post Powered Stapler Malfunction During Laparoscopic Nephrectomy first appeared on CRSLS.