CRSLS : MIS case reports from SLS最新文献

Introduction: Intercostal hernias are a rare clinical entity. They are divided into trans-diaphragmatic intercostal or abdominal intercostal hernias based upon the presence or absence of diaphragmatic injury. There are various means of repair for these hernias, including open, laparoscopic, and robotic approaches. We present the second known robotic repair of an abdominal intercostal hernia and review of the relevant literature.

Case description: A 54-year-old morbidly obese male was found to have an abdominal intercostal hernia on the right between the 9^th and 10^th ribs. His symptoms were significant for a large, tender right chest wall mass. Through a three-port approach, polypropylene mesh and circumferential sutures were used to create a double-wall of reinforcement to secure the area of weakness.

Discussion: This rare case of an intercostal hernia utilized robotic-assisted laparoscopic repair and led to a favorable outcome, whereby the patient reported significant improvement in pain, comfort, and quality of life. Thus, minimally invasive robotic surgery for this complex structural pathology can be safer and have less complications than other current treatments.

Secondary distal plasmacytoma that arise from multiple myeloma is a common hematological malignancy that manifests in later stages of the disease. These plasmacytomas are known to cause extensive systemic organ damage. When extramedullary plasmacytomas reach the gallbladder or biliary ducts, expansion can mimic acute acalculous cholecystitis or cholangiocarcinoma. We report a case of a 56-year-old female with a history of aggressive course IgA κ chain multiple myeloma who presented with right upper quadrant abdominal pain with nausea and vomiting for one week duration. Her laboratory panel revealed liver function tests consistent with gallbladder etiology. Abdominal ultrasound and CT showed no evidence of cholelithiasis precluding to acute acalculous cholecystitis. Initial medical management did not show any improvement. A robotic cholecystectomy was performed, and a pathology review of the specimen found a neoplastic stricture of the gallbladder fundus, the histological evaluation of which revealed plasmacytoid cells originating from her primary multiple myeloma diagnosis. The patient's condition declined following surgery, postoperative presentation included metastatic liver thrombosis mimicking cholangiocarcinoma and the patient later expired with palliative care.

Background and Objectives: Less than 300 cases of a De Garengeot's hernia have been published. This rare femoral hernia with the vermiform appendix included appears almost exclusively on the right side, mainly in females, and it generally debuts as an incarcerated femoral hernia. Although most of the times there is a concomitant appendicitis, clinical signs of peritonitis are absent. The wide use of radiologic exams has not favored its preoperative diagnosis, but been usually found incidentally during a surgical emergency. The best surgical approach to a De Garengeot's hernia is not totally defined and many critical questions still remain unanswered. Open surgery is considered the standard treatment procedure, but since the emergence of laparoscopy for incarcerated hernias, this is certainly an option. Methods: We report the successful laparoscopic management of an 83-year-old woman who had been operated on her right inguinal hernia, with a Rutkow-Robbins' technique, 4 months earlier. She had noticed the protrusion of a lump in her right inguinal region for 2 months. Radiological studies were not conclusive. With a miss diagnosis of a recurrent incarcerated inguinal hernia, a minimal invasive endoscopic approach was performed. A representative case of this fully laparoscopic TAPP procedure is presented. Results: The patient made an uninterrupted recovery. She left the hospital the day after in a stable condition and has enjoyed good health since. Conclusion: A fully laparoscopic TAPP approach seems perfectly safe and feasible to treat this entity, and could be considered the first line alternative when enough expertise is available.

Colorectal cancer prevention relies on effective screening through colonoscopy and polypectomy. Several techniques and methods have been described to manage complex colonic polyps such as the ones that are endoscopically unresectable. Across time, we have been able to perform less invasive techniques that include different types of colonic resections, ranging from partial thickness, full-thickness and, segmental colectomies, however, none has proven to be the treatment of choice for these lesions. The technique presented here is an attractive alternative to segmental colectomy using a robotic platform to perform a full-thickness resection.

Introduction: A parastomal hernia (PSH) is an abnormal herniation of an intra-abdominal organ or other tissue through an intentionally created fascial defect at an ostomy site. PSHs commonly involve reducible mobile segments of omentum, intra-abdominal fat, and bowel. However, PSHs may rarely involve fixed intra-abdominal organs such as the stomach. Case Description: A 68-year-old female underwent emergent Hartmann procedure for Hinchey III diverticulitis and subsequently developed a large reducible parastomal hernia. She was scheduled for an elective laparoscopic colostomy reversal. Prior to her scheduled reversal, the patient presented to the ED with anorexia, lack of colostomy output, emesis, and pain localized to her left lower quadrant. She was found to have gastric outlet obstruction secondary to herniation of the stomach through the left lower quadrant colostomy site. The patient was admitted and treated conservatively with resolution of her symptoms, but due to the high likelihood of recurrence, the decision was made to proceed with laparoscopic Hartmann colostomy reversal with coloproctostomy and primary closure of the fascia without mesh. Conclusion: The contents of a PSH can become incarcerated causing obstruction, strangulation, necrosis and even perforation over time. Fortunately, in this case, herniation of the stomach was recognized early. The patient underwent repair of the hernia defect in order to prevent recurrence of gastric herniation and its potential detrimental complications. The decision regarding the technical aspects of ostomy reversal in terms of mesh selection require further study. In our case, mesh was not used due to patient-specific factors and comorbidities.

We report a case of bile leaks post-laparoscopic cholecystectomy (LC) with initial treatment failure by common bile duct stent insertion. The injury of a subvesical duct running from gallbladder fossa toward an area of fluid accumulation that was not revealed by computed tomography and endoscopic retrograde cholangiopancreatography previously, was eventually found by magnetic resonance cholangiopancreatography (MRCP) and proved to be the cause of bile leak. Also, several tiny branches in the right liver instead of a main trunk and another subvesical duct draining into the common bile hepatic duct was noted. These anatomic variations were scarcely reported, especially by MRCP. The aim of this case report is to discuss the link between biliary tree anomaly and bile leak due to bile duct injury during LC in our experience treating one patient. Also, we review related literature to understand more on prevention or management of subvesical duct injury.

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 45.8 ± 14.0 months (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 feasible and safe, with a low risk of chronic pain and recurrence.

We report a case of a 21-year-old male who presented with adult-onset dysphagia after previous Nissen fundoplication initially created at age 10.5 months. The patient first presented one year ago to a different hospital, where he underwent extensive workup for his symptomatology. Physiologic tests performed were esophagogastroduodenoscopy (EGD), abdominal ultrasound, hepatobiliary iminodiacetic acid scan, esophageal manometry, and lactulose breath test. The EGD identified stricture at the level of the gastroesophageal junction. The other studies did not reveal other physiologic causes for his symptoms. The patient then presented to our institution, at which time a repeat EGD showed evidence of tight Nissen fundoplication. The patient subsequently underwent laparoscopic exploration, which revealed that the fundoplication had was partially disrupted, herniated, and twisted causing a long-segment distal stricture. To alleviate the patient's presenting symptom of dysphagia as well as prevent possible future reflux, it was decided to convert repair the hernia and revise the Nissen into a partial fundoplication. This was successfully accomplished laparoscopically with subsequent resolution of the patient's symptoms.

Introduction: The occurrence of pregnancy with Cushing syndrome (CS) is rare but with high risks, posing a great challenge to the clinical diagnosis and treatment of the disease.

Case description: From Aug 2016 to Aug 2019, we admitted two pregnant women with CS caused by adrenal tumors. After multidisciplinary consultation, they underwent emergency Cesarean section because of heart failure and severe hypoxemia, and finally delivered a living baby after adjuvant therapy. Both patients underwent retroperitoneal laparoscopic adrenectomy (RLA) 2.6 and 1.5 months postpartum to have the adrenal tumors removed successfully. The postoperative pathology confirmed the adrenal tumor as adrenocortical adenoma. Partial hormone replacement therapy was initiated postoperatively and withdrawn uneventfully 1 year after RLA in both patients, and both patients have recovered well.

Conclusions: It is difficult to find CS in early pregnancy, and when it is detected in late pregnancy, it often poses a great risk because it is necessary to consider the safety of both mother and fetus, which requires multidisciplinary coordination and cooperation to positively adjust the cardiopulmonary function and internal environment after Cesarean section, knowing that timely RLA to remove the adrenocortical adenoma can effectively cure CS.