Hydatid cysts in the mesocolon mimicking peritoneal pseudomyxoma in a post-appendectomy patient: A case report.

We aimed to present a case of two mesocolonic hydatid cysts that mimicked the presentation of peritoneal pseudomyxoma. Hydatidosis is a zoonotic parasitic infection caused by the cestode Echinococcus spp., whose larval stage affects various organs. The present case describes a 40-year-old male patient who presented with severe lower abdominal pain and was diagnosed with acute appendicitis. The patient underwent an appendectomy and was later referred to an oncology surgery clinic because of imaging findings suggestive of peritoneal pseudomyxoma or carcinomatosis. A video-assisted laparoscopic procedure revealed two cysts and microscopic findings confirmed hydatid cysts. The patient was from a hydatidosis-endemic region of southern Brazil. This case highlights the diagnostic challenges and the need for a multidisciplinary approach and careful histopathological analysis in patients with complex abdominal conditions. This also demonstrates the importance of disseminating knowledge about this condition and its management.

Long-term Functional and Patient-reported Outcomes Between Intra-corporeal Delta-shaped Gastroduodenostomy and Gastrojejunostomy After Laparoscopic Distal Gastrectomy.

PURPOSE: This study aimed to compare the long-term functional and patient-reported outcomes between intra-corporeal delta-shaped gastroduodenostomy and gastrojejunostomy after laparoscopic distal gastrectomy for gastric cancer. MATERIALS AND METHODS: We retrospectively reviewed clinicopathological data from 616 patients who had undergone laparoscopic distal gastrectomy for stage I gastric cancer between January 2015 and September 2020. Among them, 232 patients who had undergone delta-shaped anastomosis and another 232 who had undergone Billroth II anastomosis were matched using propensity scores. Confounding variables included age, sex, body mass index, physical status classification, tumor location, and T classification. Postoperative complications, nutritional outcomes, endoscopic findings, and quality of life (QoL) were compared between the 2 groups. RESULTS: No significant differences in postoperative complications or nutritional parameters between the two groups were observed. Annual endoscopic findings revealed more residual food and less bile reflux in the delta group (P<0.001) than in the Billroth II group. Changes of QoL were significantly different regarding emotional function, insomnia, diarrhea, reflux symptoms, and dry mouth (P=0.007, P=0.002, P=0.013, P=0.001, and P=0.03, respectively). Among them, the delta group had worse insomnia, reflux symptoms, and dry mouth within three months postoperatively. CONCLUSIONS: Long-term nutritional outcomes and QoL were comparable between the delta and Billroth II groups. However, more residual food and worse short-term QoL regarding insomnia, reflux symptoms, and dry mouth were observed in the delta group. Longer fasting time before endoscopic evaluation and short-term symptom management would have been helpful for the delta group.

Comparing Outcomes of Robotic-Assisted versus Conventional Laparoscopic Hiatal Hernia Repair.

Introduction: Robotic-assisted laparoscopic surgery for anti-reflux and hiatal hernia surgery is becoming increasingly prevalent. The purpose of this study was to compare hospital length of stay and outcomes of robotic-assisted versus conventional laparoscopic hiatal hernia repair. Methods: A retrospective review was conducted of 58 patients who underwent robotic-assisted laparoscopic (n = 16, 27.6%) or conventional laparoscopic (n = 42, 72.4%) hiatal hernia repair. Results: Patient characteristics and comorbidities were similar between groups. The robotic-assisted group had a significantly higher use of fundoplication (81.3% vs. 38.1%; p = 0.007). Complications observed between the robotic-assisted and conventional laparoscopic groups were pneumothorax (6.3% vs. 11.9%; p = 1.000), infection (0% vs. 4.8%; p = 1.000), perforation (0% vs. 2.4%; p = 1.000), bleeding (6.3% vs. 2.4%; p = 0.479), ICU admission (31.3% vs. 11.9%; p = 0.119), and mechanical ventilation (18.8% vs. 2.4%; p = 0.60). There were no reported complications of dysphagia, deep vein thrombosis/pulmonary embolus, myocardial infarction, or death in either group. Hospital length of stay was similar for robotic versus conventional patients (3.0 vs. 2.5 days; p = 0.301). Conclusions: Robotic-assisted versus conventional laparoscopic hiatal hernia were compared, which demonstrated similar post-operative complication rates and hospital length of stay. The results showed robotic-assisted or conventional laparoscopic hiatal hernia repair can be performed with similar outcomes.

Endotracheal tube cuff pressure during laparoscopic bariatric surgery: highs and lows.

BACKGROUND: Gastric calibration tubes (GCTs) are a unique component of bariatric surgery. This study aimed to assess changes in the endotracheal tube (ETT) cuff pressure during laparoscopic bariatric surgery. METHODS: This was a prospective observational study consisting of 124 American Society of Anesthesiologists class I-III morbidly obese patients (body mass index > 40 kg/m2 ) undergoing elective laparoscopic bariatric surgery under general anesthesia. The baseline ETT cuff pressure was 28 cmH2O. Cuff pressure, peak airway pressure, and hemodynamic changes were observed during various steps of bariatric surgery. Immediate postoperative complications during the first 24 h were recorded. RESULTS: ETT cuff pressure increased significantly from the baseline (28 cmH2O) after insertion of GCT (36.3 ± 7.3 cmH2O) and creation of carboperitoneum (33.3 ± 3.8 cmH2O). Cuff pressure decreased significantly on GCT removal (24.0 ± 3.0 cmH2O) and release of carboperitoneum (24.7 ± 3.0 cmH2O). Peak airway pressure increased from the initial baseline value of 25.1 ± 3.7 to 26.5 ± 4.5 after GCT insertion, creation of carboperitoneum (32.6 ± 4.4), attainment of reverse Trendelenburg position (32.3 ± 4.0), and subsequent return to supine position 32.5 ± 4.8. CONCLUSIONS: The endotracheal cuff pressure significantly varies during the intraoperative period. Routine monitoring and readjustment of cuff pressure are advisable in all laparoscopic bariatric surgeries to minimize the possibility of postoperative complications.

Natural orifice specimen extraction (NOSE) surgery with rectal eversion and total extra-abdominal resection.

BACKGROUND: Natural orifice specimen extraction (NOSE)surgery is gaining popularity among colorectal surgeons. The technical aspects of this new procedure are still debated and many variations have been presented in the last decade. METHODS: We propose a new variation of transanal NOSE after robotic and laparoscopic LAR consisting of rectal eversion by using a special rod after laparoscopic TME. Eversion makes it possible to perform resection and placement of the anvil extracorporeally. We included a video demonstration of the technique. Clinical Patient Grading Assessment Scale was calculated 1 month after stoma closure and the Low Anterior Resection Syndrome (LARS )score was calculated preoperatively and 1 month after stoma closure. RESULTS: Seven female patients with rectal cancer, all with normal BMI, underwent laparoscopic (n = 5) or robotic (n = 2) TME with rectal eversion. No intraoperative and postoperative complications were reported. One month after stoma closure, the median Clinical Patient Grading Assessment Scale was 5 (range 3-7), which means "a good deal better". The median LARS score was 14 (IQR 14-19,5) preoperatively and 19 (IQR 19-21,5) 1 month after stoma closure. CONCLUSIONS: This variation of NOSE surgery was safe and effective in our patient population.

[Standard surgery for small renal masses (<4 cm)]. / Standardoperationen bei kleinen Nierentumoren (<4 cm).

BACKGROUND: Several new treatment strategies have emerged in the treatment of small renal masses (<4 cm in diameter). Active surveillance and ablative techniques have been introduced but it remains unclear which patients will benefit the most from these new treatment options. A surgical approach remains standard of care. In recent decades, radical nephrectomy has been replaced by nephron-sparing surgery for the management of small renal masses. RESULTS: In addition to the open partial nephrectomy, which is considered the standard approach, the number of surgeries performed using minimally invasive techniques is increasing. Recent data show that there might be some benefits such as less blood loss. The disadvantages shown by laparoscopic partial nephrectomy such as prolonged warm ischemia, longer operation times, and postoperative renal impairment might be negligible for the robotic approach. Therefore, current guidelines allow these approaches in addition to open partial nephrectomy if sufficient surgical expertise is given.

Application of temporary inflow control of the Glissonean pedicle method provides a safe and easy technique for totally laparoscopic hemihepatectomy by Glissonean approach.

The Glissonian approach, due to its simplicity of procedure, is a technical procedure widely used in open hepatectomy. However, it is not easily applicable in the setting of the total laparoscopic approach because of movement restriction. We herein propose a new and simple method of performing hemihepatectomy by Glissonian approach called temporary inflow control of the Glissonian pedicle (TICGL) technique. Dissection of the Glisson pedicle from the liver parenchyma is done until the posterior margin of the pedicle is visualized, and is clamped with bulldog clamps. Encircling the pedicle is not necessary. Resection of the liver parenchyma is performed under inflow control of the resected side liver providing less bleeding. After sufficient resection is done so that the whole Glissonian pedicle structures are visualized, the pedicle is encircled, often very easily without the fear of bleeding from the posterior side of the pedicle, which is a common problem when encircling is done before parenchymal resection. The staplers may then be applied safely without injuring the major hepatic veins since they have been already exposed. Stapling is done while the tape is retracted toward the contralateral side. This retraction prevents injury or stricture of the contralateral Glissonian pedicle branch. The remnant liver parenchyma is resected and hepatectomy finalized. The TICGL technique provides a safe and easy way of performing major hemihepatectomies, not only by expert laparoscopic surgeons but by less experienced surgeons. It can therefore become a standard method of performing hemihepatectomy by Glissonian approach.

The Impact of High Surgical Volume on Outcomes From Laparoscopic (Totally Extra Peritoneal) Inguinal Hernia Repair.

PURPOSE: Laparoscopic hernia repair is characterised by a steep learning curve for the surgeon, and proficiency and outcomes are dependent on experience. The aim of this study was to compare laparoscopic totally extra peritoneal (TEP) inguinal hernia repair outcomes conducted by a single surgeon as experience changed over time. MATERIALS AND METHODS: Clinical records of 100 consecutive patients who underwent laparoscopic TEP inguinal hernia repair (n=113 hernias) at Kent and Canterbury Hospital by a single laparoscopic surgeon over a four-year period were reviewed for postoperative outcomes. Outcomes were compared with a previous cohort of patients undergoing TEP repair in the preceding three years. RESULTS: One patient experienced chronic postoperative pain, but there were no recurrences, wound infections, haematomas, or conversions compared to three recurrences, three conversions to open operations, one haematoma, and one episode of postoperative pain in the preceding period. CONCLUSIONS: Laparoscopic TEP inguinal hernia repair can be further improved with surgical proficiency and high surgical volumes.

Laparoscopic total colectomy and proctocolectomy for the treatment of familial adenomatous polyposis.

OBJECTIVE: To evaluate the safety, feasibility and efficacy of Laparoscopic prophylactic treatment of familial adenomatous polyposis (FAP). METHODS: Perioperative data and surgical outcomes of 11 FAP patients who underwent laparoscopic surgery between January 2012 and June 2014 in our hospital were analyzed retrospectively. Results 2: Patients had laparoscopic total proctocolectomy with ileostomy, and 9 patients had laparoscopic total colectomy with ileorectal anastomosis. The median number of harvested lymph nodes was 36 (range, 21~46). The mean operating time was 330 minutes with a range of 240 to 380 minutes. Blood loss ranged from 90 to 200 ml with a median being 150 ml. The median incision length was 4 (3-5) cm. The bowel function recovered by the third (range from 2~4 day) postoperatively. The follow-up time of these patients were 3~32 months (median 20 months) respectively and no local recurrence or distant metastases were found. CONCLUSION: Laparoscopic prophylactic treatment for FAP can be performed safely and effectively with the advantage of minimal invasion by experienced surgeons.

Modified laparoscopic intravesical nonrefluxing ureteral reimplantation with psoas hitch using a submucosal tunneling.

We aimed to study the safety and efficacy of the cystoscopy-assisted nonrefluxing ureteral reimplantation technique using submucosal tunneling during laparoscopic ureteroneocystostomy (UNC) with a psoas hitch in patients with distal ureter stricture after gynecologic surgery. We reviewed six female patients who underwent gynecological surgeries. All patients showed persistent postoperative distal ureter stricture or obstruction. These patients underwent laparoscopic nonrefluxing UNC with a psoas hitch using a submucosal tunneling technique combined with cystoscopy at our institute. They had corrective surgery at an average of 13.3 weeks after ureteral injury. The short-term success was confirmed either by voiding cystourethrography (VCU) or by diuretic isotope renal scan (MAG-3) conducted 3 months after the operation. None of the patients showed evidence of postoperative stricture at the reimplanted site and reflux on either MAG-3 renal scan or VCU. None of the patients showed major or minor complications during follow-up. It is safe and feasible to perform the laparoscopic nonrefluxing UNC with a psoas hitch using a submucosal tunneling technique combined with cystoscopy for ureteral stricture.

Laparoscopic management of impalpable undescended testes: 20 years' experience.

BACKGROUND: Laparoscopy is the best available method to manage impalpable undescended testes. We performed our first laparoscopic orchiopexy in June 1992 and found good results in consecutive cases with laparoscopic orchiopexy over last 20 years. MATERIALS AND METHODS: From June 1992 to May 2012, 241 patients with 296 impalpable testes were operated upon by laparoscopic approach. One-stage laparoscopic orchiopexy was performed in 152 cases, while two-stage Fowler - Stephens laparoscopic orchiopexy was performed in 55 cases. Laparoscopic orchiectomy was required in 20, and in 21 patients testes were absent. One-sided laparoscopic orchiopexy was performed in a male pseudo hermaphrodite. RESULTS: None of the testis atrophied after two-stage Fowler - Stephens laparoscopic orchiopexy, while in 152 cases of single-stage orchiopexies one testes atrophied. One patient developed malignant change in the testis, 6 years after orchiopexy. CONCLUSIONS: Laparoscopy is the best way to diagnose impalpable undescended testes. No other imaging investigation was required. Single-stage laparoscopic orchiopexy for low level undescended testis has very good results. For high-level undescended testis and when one-stage mobilisation is difficult, two-stage Fowler - Stephens orchiopexy has excellent results. Minimum 4 months should separate first and second stage of laparoscopic Fowler - Stephens procedure. Even when open orchiopexy is being done for intra-canalicular testes in a child, it is advisable to be ready with laparoscopy if necessary, at the same time, in case open surgery fails to mobilise the testicular vessels adequately.