Asian Journal of Endoscopic Surgery最新文献

Arcuate line hernia (ALH) is a rare internal hernia in which abdominal contents protrude into the retrorectus space through a defect between the arcuate line and rectus abdominis. Because the bulge lies behind the rectus abdominis muscles, symptoms are often non-specific, making diagnosis difficult. A 73-year-old woman presented with intermittent left lower abdominal pain. Thin-slice prone computed tomography obtained during the Valsalva maneuver demonstrated small bowel herniation through the left arcuate line, consistent with ALH, along with a concomitant umbilical hernia. Laparoscopic intraperitoneal onlay mesh (IPOM) repair was performed using a composite mesh covering both defects with adequate overlap, secured with transfascial sutures and absorbable tacks. The postoperative course was uneventful; the patient was discharged on postoperative Day 3 and remained symptom-free without recurrence at 1 year. To our knowledge, this is the first reported case of ALH with a concurrent umbilical hernia repaired laparoscopically using the IPOM technique.

We report the first infant case of congenital biliary dilatation (CBD) treated using the da Vinci SP system. A 4-month-old boy (7.9 kg) with Todani type IV-A CBD underwent complete extrahepatic bile duct excision, hilar bile duct plasty, and hepaticojejunostomy through a 2.7-cm umbilical incision with an additional 3-mm assistant port. Operative time was 343 min with minimal blood loss. Recovery was uneventful, and the patient was discharged on postoperative day 7. This case demonstrates the feasibility of SP-assisted minimally invasive surgery in small infants.

Jejunal intussusception is a rare but potentially serious complication of gastric surgery, typically involving the gastrojejunostomy or alimentary limbs. A 75-year-old woman underwent laparoscopic distal gastrectomy with D1+ lymphadenectomy and Roux-en-Y reconstruction for early-stage gastric cancer. Postoperatively, she developed intermittent vomiting every 10 days without identifiable triggers and was managed conservatively. However, transient jejunal intussusception involving the bilopancreatic limb was later identified at the jejunojejunal site. Although the intussusception resolved spontaneously, her symptoms persisted. Laparoscopic reoperation revealed mild bulging at the jejunojejunostomy site and a bilopancreatic limb measuring approximately 40 cm, considerably longer than the intended 25 cm. The segment was resected and reconstructed in the antiperistaltic direction using a 25-cm limb. Postoperatively, the patient's symptoms resolved completely. Even minor intraoperative misjudgment of bilopancreatic limb length may lead to functional complications such as intussusception. Awareness of this rare complication can help guide surgical decision-making and postoperative management, ultimately improving patient outcomes.

Gastric fundal false diverticula are exceedingly rare, and to our knowledge, this is the first reported case occurring in association with a sliding hiatal hernia. We describe a 49-year-old woman who presented with persistent dysphagia, regurgitation, heartburn, and halitosis refractory to medical therapy. Imaging revealed a 5.0 × 3.6 × 4.7 cm false diverticulum at the posteromedial fundus and a sliding hiatal hernia. Esophageal manometry demonstrated normal motility with ineffective bolus clearance. Laparoscopic management was employed, combining intraoperative endoscopy for diverticulum localization and staple-line verification with laparoscopic dissection and repair. The procedure included diverticulum excision with an endoscopic stapler, posterior crural closure reinforced with pledgeted sutures, and anterior partial fundoplication. Histopathology confirmed a false diverticulum with complete absence of the muscularis propria layer and no malignancy. At the 1-year follow-up, the patient reported significant symptom resolution. This case highlights the laparoscopic management in complex gastric diverticula and provides a valuable surgical option for similar cases.

Sinistral portal hypertension is caused by various pancreatic pathologies, including neoplasms. Bleeding from the collateral circulation due to sinistral portal hypertension obscures the operative field during laparoscopic distal pancreatectomy. A female patient in her 40s presented with a mucinous cystic neoplasm complicated by sinistral portal hypertension that was successfully managed with splenic arterial embolization followed by laparoscopic distal pancreatectomy. The intraoperative blood loss was minimal, and the patient did not require blood transfusions during the perioperative period. Preoperative splenic arterial embolization is feasible, safe, and effective in avoiding massive hemorrhage from the collateral circulation due to sinistral portal hypertension during laparoscopic distal pancreatectomy.