Intraoperative portal vein stenting through umbilical vein approach: An innovative salvage procedure for portal vein thrombosis in pediatric liver transplant.

BACKGROUND: IPVS is considered a last resort or a salvage procedure in the event of recurrent PV thrombosis despite multiple attempts at redo PV anastomosis. We employed the opened umbilical vein approach to place the stent in the PV and deliver anticoagulation through a catheter. MATERIALS AND METHODS: From Jan 2017 to Feb 2022, 150 patients underwent pediatric transplantation at department of liver transplant and hepatobiliary surgery unit, Indraprastha Apollo hospitals, New Delhi. Age, weight, PELD Score, diagnosis, portal vein diameter on preoperative CT, Portal flow after stenting, decrease in spleen size after stenting in follow-up CT were collected from a prospectively maintained data base and reviewed. RESULTS: Eight patients underwent IPVS following LDLT (mean age-10.6 ± 2.2 months, mean weight 8.1 ± 1.6, mean PELD score 32.7 ± 7.3). The mean PV diameter on preoperative CT scan was 3.6 mm (range 2.7-5.6 mm). The mean portal flow following stenting was 718.75 cc/min. Percentage reduction in size of the spleen was 26.35% beyond 2nd post-operative week. No patient had recurrent PV thrombosis following IPVS and all maintained an adequate portal flow throughout the immediate postoperative period. Two patients had in-hospital mortality secondary to septic complications. CONCLUSION: Umbilical vein approach is technically feasible, easy to manipulate the stent and catheter placement after stenting helps to deliver anticoagulants locally.

Unexplained ascites following laparoscopic cholecystectomy: A surgeon's nightmare - A case report and review of literature.

Laparoscopic cholecystectomy has many known complications which can be ascertained to a particular cause. We report a case of ascites development in a young female immediately after Laparoscopic cholecystectomy, for which a cause cannot be found. On review of medical literature, there are few similar case reports, based on them; it can be ascertained to acute allergic reaction to the material used during the procedure may be the CO2 or the electrocautery.

Malignant masquerade sclerosing mesenteritis: A case report and review.

Mesenteric panniculitis (MP), also known as sclerosing mesenteritis (SM), retractile mesenteritis or mesenteric lipodystrophy, is a rarely diagnosed inflammatory condition of unknown etiology that involves the mesenteric adipose tissue. We are presenting a case of sclerosing mesenteritis which presented us with features suggestive of malignant lesion and turned out to be benign one. An elderly gentleman of 68 years male presented to us with history of nonprogressive pain abdomen since 2 months associated with low grade fever and on and off constipation. On evaluation with CECT he was found to have mesenteric mass probably malignant. PET/CT showed an FDG avid lesion suggestive of malignancy, requiring surgery. He underwent radical excision of mesentery with resection of corresponding bowel. Final histopathology report showed poorly defined lesion comprised of nodular, poorly defined proliferation of bland looking fibroblast like cells, which at places are lying in fascicles, in a background of dense fibrosis and mature fat cells, with prominent focal lymphocytic infiltrate, at place forming reactive follicles, suggestive of sclerosing mesenteritis. Now patient is on follow up for further therapy.

Sporadic Desmoid-Type Fibromatosis Occurring at Laparoscopic Trocar Site: An Unusual Entity.

Desmoid-type fibromatosis (DF) or desmoid tumours are rare benign soft tissue tumours of musculo-aponeurotic origin, which have no malignant potential but are locally aggressive and can result in significant morbidity. They may be hereditary (in association with FAP, i.e. familial adenomatous polyposis syndrome resulting from APC gene mutation) or sporadic, with hereditary cases having a much higher risk of developing DF compared to sporadic ones. Desmoids are known to occur in previous surgical scars. However, previous laparoscopic port site/trocar site is an extremely uncommon site for sporadic desmoids, with only two cases of sporadic laparoscopic trocar site desmoids (occurring in absence of FAP) reported in world literature. We thus describe a case of sporadic DF, occurring at the site of umbilical port 8 months following laparoscopic cholecystectomy for cholelithiasis, treated successfully by margin-negative resection. To the best of our knowledge, this appears to be the first such case in Indian literature and the first being reported after laparoscopic cholecystectomy. In the era of laparoscopic surgery, one must be aware of the existence of such an entity after laparoscopy as it may be confused with conditions such as metastatic deposit, port site tumour recurrence, port site hernia, scar site endometriosis, soft tissue sarcoma etc. and may result in diagnostic dilemma.

Evaluation of gastroesophageal reflux after laparoscopic cholecystectomy using combined impedance-pH monitoring.

BACKGROUND AND AIM: Postoperative gastroesophageal reflux (GER) is one of the causes of post-cholecystectomy syndrome (PCS). Reports studying the effect of cholecystectomy on GER show conflicting results and only a few studies have used the more sensitive technique of combined impedance-pH monitoring. This study aimed to study the effect of laparoscopic cholestectomy on GER (acid/non-acid reflux) using impedance-pH monitoring. METHODS: Sixty three consecutive patients of symptomatic cholelithiasis were evaluated. All patients underwent esophageal mannometry and 24-hour impedance-pH monitoring pre- and postoperatively. Frequency scale for the symptoms of GERD (FSSG) scoring was also done in each patient pre- and postoperatively. RESULTS: Out of sixty three patients, four developed symptoms of reflux postoperatively as detected by FSSG scoring. However, no significant changes were observed in lower esophageal sphincter (LES) characteristics, acid and non-acid reflux characteristics, total number of reflux episodes, or in the physical character of the refluxate following laparoscopic cholecystectomy. Significant decrease in the proximal acid reflux episodes was observed. CONCLUSION: The chemical characteristics (acid or non-acid reflux) as well as physical properties (liquid, gas or mixed) of reflux episodes remain unaffected following laparoscopic cholecystectomy. Cholecystectomy itself doesn't increases GER.