Department of Surgery, Damsoyu Hospital, Seoul, Republic of Korea.

ABSTRACT

Background and Objectives: In patients with inguinal hernias who have undergone radical prostatectomy, dissecting the medial preperitoneal space is difficult because of the presence of fibrotic scars. It is also difficult to guarantee sufficient space for mesh implantation. We added laparoscopic iliopubic tract repair (IPTR) to transabdominal preperitoneal (TAPP) hernioplasty, and evaluated this for the treatment of inguinal hernias after radical prostatectomy

Methods: This retrospective study included 29 male patients with inguinal hernias after radical prostatectomy who underwent TAPP hernioplasty between January 1, 2015 and October 31, 2018. Laparoscopic IPTR was performed first, followed by TAPP hernioplasty.

Results: All patients had an indirect inguinal hernia. The mean time from radical prostatectomy to TAPP hernioplasty was 2.1 years (range, 0.3–11 years). In one patient, the peritoneal flap was insufficient, and the operation was performed using a dual-layer mesh. All other patients underwent conventional TAPP hernioplasty. The mean operation time was 42 min (range, 30–50 min), and the mean duration until return to normal activities was 8.4 days. There were two minor postoperative complications (one hematoma and one seroma). The mean follow-up period was 45.8614.0months (range, 22–67 months), and chronic pain or recurrence was not observed.

Conclusion: Adding laparoscopic IPTR to TAPP hernioplasty in patients with a history of radical prostatectomy is feasi- ble and safe, with a low risk of chronic pain and recurrence.

Key Words: Inguinal hernia, Hernioplasty, Prostatectomy, Laparoscopy.

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Department of Pediatric Gastroenterology, NY Medical College, Westchester Medical Center, Valhalla, New York, USA (Drs Shaban, Cukaj, Sood, and Bostwick).
Department of Surgery, Division of Pediatric Surgery, NY Medical College, Westchester Medical Center, Valhalla, New York, USA (Dr Stringel).
New York Medical College, Westchester Medical Center, Valhalla, New York, USA (Dr. Helfgott).

ABSTRACT

Introduction: Vascular malformations remain a rare cause of gastrointestinal (GI) bleeding, and they can present a diagnostic challenge. The diagnostic utility of video capsule endoscopy in identifying these malformations in the pediatric population is not well documented.

Case Description: A 7-y-old male with chronic iron deficiency anemia had a clinical history of melon and occasional hematochezia of 1-year duration requiring multiple admissions to the hospital and blood transfusions. Ultrasound, Meckel scan, magnetic resonance imaging, and computed tomography (angiogram) did not demonstrate the source of bleeding. Upper and lower endoscopy studies showed no abnormalities. A video capsule endoscopy showed a lesion in the small intestine suggestive of an arteriovenous malformation. Diagnostic laparoscopy identified the vascular malformation in the mid jejunum. Laparoscopic-assisted intestinal resection including the malformation was successfully performed. After surgical resection, the anemia resolved, and the patient had no further episodes of bleeding.

Conclusions: This case illustrates the utility of video capsule endoscopy combined with laparoscopy in the management of a suspected GI arteriovenous malformation in pediatric patient.

Key Words: Anemia; Arteriovenous Malformation; Gastrointestinal Bleeding; Laparoscopy; Pediatric; Video Capsule Endoscopy.

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Department of Obstetrics and Gynecology, Jamaica Hospital Medical Center, Jamaica, New York, USA (All authors).

ABSTRACT

Introduction: A 30–year-old gravida 2 para 1 woman was referred to us for further evaluation of pelvic mass from another center. She gave a history of cesarean delivery, multiple pelvic infections, and suspected pelvic mass. Patient was taken to the operating room after initial evaluation and imaging. Cervical diverticulum was identified and treatment carried out laparoscopically. The patient experienced an uneventful recovery and was completely free of the symptoms for 6 months.

Conclusion: Cervical diverticulum should be considered as a differential diagnosis and laparoscopic surgery should be considered as a treatment of choice for Mu ̈llerian anomalies.

Key Words: Cervical Diverticulum; Laparoscopy; Pelvic Mass; Pelvic Infection.

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Department of Surgery, Hospital Episcopal San Lucas, Ponce, Puerto Rico, USA (Drs Fraticelli-Rosado, Ruiz-Deya, and Rodriguez Vega). Transitional Residency Program, Hospital Damas, Ponce, Puerto Rico, USA (Dr. Cochran-Perez). Ponce Health Sciences University, Ponce, Puerto Rico, USA (Dr. Ruiz-Deya).

ABSTRACT

Introduction: Scrotal liposarcoma is a very rare scrotal malignancy that is a diagnostic and therapeutic challenge for the treating surgeon.

Case Description: A 47-year-old man presented with a recent onset of bilateral testicular swelling and increasing discomfort. The patient had undergone an uneventful laparoscopic bilateral inguinal hernia repair 6 months prior and had been symptom free at 1 month after surgery. Now, the patient had developed recurrent swelling of his right scrotal area and nocturia. A computed tomographic scan revealed a lipomatous mass extending into the inguinal canal, and a decision was made to explore and resect the mass via a laparoscopic approach. Exploration revealed a large fatty mass extending from the inguinal canal to the retropubic space. After careful dissection of the mass off the inguinal vessels, it was pushed into the inguinal canal for later removal through the scrotum. The inguinal defect was covered with an absorbable mesh via laparoscope, and the dissection and transscrotal removal of the fatty mass was completed. Pathology revealed scrotal liposarcoma. At the 4-month follow-up, the patient was asymptomatic and a computed tomographic scan revealed no masses or signs of recurrence. At the 1-year follow-up, the patient remained disease free.

Conclusion: This case demonstrates an uncommon scrotal malignancy. Open surgery with orchiectomy is the surgical technique that most surgeons use. We have demonstrated that a laparoscopic approach is a viable alternative that can provide negative margins and testicular preservation.

Key Words: Laparoscopy, Orchiectomy, Scrotal liposarcoma, Scrotal mass.

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Department of Obstetrics and Gynecology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea (Dr. Yi).

ABSTRACT

Introduction: Cornual pregnancy on the same side as a previous salpingectomy is a very rare pathologic condition in cases of spontaneous pregnancy.

Case Description: A 31-year-old woman (gravida 2, para 0) was admitted with abdominal pain and vaginal hemorrhage. She had a history of laparoscopic left salpingectomy for tubal pregnancy 6 years ago at another hospital. Two-port laparoscopy with a multichannel port was performed and revealed a left cornual pregnancy with hemoperitoneum. Five months later, she visited our emergency department because of abdominal pain. We performed 2-port laparoscopy, using a multichannel port for a left cornual pregnancy with hemoperitoneum.

Discussion: Two-port laparoscopy with a multichannel port for recurrent cornual pregnancy was relative safe and easy, with the advantages of reduced surgical morbidity, less bleeding, and shorter operative time.

Key Words: Cornual pregnancy, Laparoscopy, Recurrence, Salpingectomy, Salpinx.

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School of Medicine (Mr Lee) and Department of Surgery (Dr Perez), Duke University Medical Center, Duke University, Durham, North Carolina, USA.

ABSTRACT

Introduction: Gastric diverticulum is a rare condition that has been surgically managed in the past for a wide range of symptoms. These symptoms include nonspecific reflux, pain, abdominal bloating, dyspepsia, vomiting, and oral fetor, alongside more serious complications such as hemorrhage or malignancy. Although complications, such as hemorrhage or perforation, clearly indicate surgical intervention, the question of when to pursue diverticulectomy in the case of other milder and persistent symptoms is still unclear. In the case of oral fetor, three previous case reports indicated complete resolution after diverticulectomy.

Case Description: A 65-year-old man with longstanding halitosis underwent an extensive workup including endoscopy, computed tomography (CT) of the abdomen and pelvis, and barium swallow. He was found to have a large gastric diverticulum and elected to undergo resection. There was no significant intraoperative blood loss, and postoperative recovery was uneventful. However, the patient continued to experience persistent oral fetor 5 months after the diverticulectomy and returned to previously used conservative measures, such as peppermint and chlorophyll.

Conclusion: Given the subjective nature of what a patient considers to be resolution of halitosis, our report presents an argument for conservative management of gastric diverticulum, even after alternative causes of halitosis have been investigated.

Key Words: Diverticulum, Halitosis, Laparoscopy, Stomach.

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School of Medicine (Mr Anderson) and Department of Surgery (Drs Pappas and Perez), Duke University Medical Center, Duke University, Durham, North Carolina, USA.
Department of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada (Dr. Rialon).

ABSTRACT

Introduction: Duodenal duplication cysts are rare congenital malformations that are most often identified incidentally and managed nonoperatively. Because of the location of the cyst, it can obstruct the biliopancreatic ampulla requiring operative intervention. An open surgical approach is the conventional procedure for these patients.

Case Descriptions: Since 1990, our institution has resected 3 duodenal duplication cysts. Symptomatic 15- and 17-year-olds underwent open resection of duplication cysts. Most recently, a 25-year-old woman presented with recurring pancreatitis and was subsequently diagnosed with a duodenal cyst on computed tomographic scan and endoscopic ultrasonography. The patient was taken to the operating room for laparoscopic excision. Operative time for the laparoscopic approach was 2 hours and 45 minutes, with no significant intraoperative blood loss. Postoperative recovery was uneventful in all cases.

Discussion: After identification of appropriate operative candidates, laparoscopic resection for duodenal duplication cysts is a feasible procedure that provides smaller incisions and decreased blood loss.

Key Words: Duodenal duplication cyst, Laparoscopic resection, Laparoscopy, Surgical treatment.

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Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA (all authors).

ABSTRACT

Introduction: There is a lack of information in the literature regarding acute appendicitis in the setting of acute diverticulitis. As acute appendicitis and acute diverticulitis together make up most community-acquired complicated intra-abdominal infections, it is very likely that the provider will encounter them in the patient presenting with abdominal pain.

Case Description: We report a patient with recurrent diverticulitis who carried a codiagnosis of acute appendicitis; the appendix was laparoscopically removed, and her diverticulitis flare was managed nonoperatively.

Discussion: In the patient with a history of diverticulitis presenting with abdominal pain, a high index of suspicion for other coexisting intra-abdominal pathology must be maintained. Computed tomography offers a powerful tool to aid in diagnosis.

Key Words: Appendicitis, Diverticulitis, Laparoscopy, Surgery.

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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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Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA (Dr. Stemmer). Virtua Hospital, Voorhees, NJ, USA (Dr. Stemmer). Genesis Biotechnology Group, Medical Diagnostic Laboratories LLC, Hamilton, NJ, USA (Dr. Shurshalina).

ABSTRACT

Introduction: There has been a scarcity of cases of isolated fallopian tubes torsion in the literature.

Case Description: Isolated fallopian tube torsion in a 27-year-old woman was associated with a hydrosalpinx. Laparoscopic detorsion of the right fallopian tube was performed within 24 hours of the onset of clinical symptoms. Surgical management was based on evaluation of tubal status and visual restoration of local perfusion as evidenced by the pink color of the untwisted tube and tested patency.

Discussion: Conservative surgical management to maximize fertility preservation should be the goal of treatment of women of reproductive age. Successful salvaging of tubal integrity rests on a low threshold for surgical management, the time from onset of symptoms to detorsion, the degree of tissue damage due to ischemia, and predisposing factors for tubal torsion.

Key Words: Tubal torsion, Hydrosalpinx, Laparoscopy.

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