Full endoscopic minimally invasive extraperitoneal modified Sugarbaker approach for para-colostomy hernia repair: Technical aspects and 2-year follow-up results of a prospective cohort.

AIM: This study aimed to assess technical aspects and clinical results of a new minimally invasive technique in parastomal hernia (PSH) repair, full endoscopic retromuscular access, after 2 years of follow-up. METHODS: Data from consecutive patients requiring minimally invasive ventral PSH repair were collected from 2019 to 2022. The inclusion criteria were patients aged between 18 and 80 years old with symptomatic PSH. Demographics and perioperative and postoperative data were collected. Postoperative pain and functional recovery were compared with preoperative data. RESULTS: Twelve patients with symptomatic PSH were included. The mean PSH defect area was 16.2 cm2 and the mean midline defect was 8.7 cm2 . No intra-operative complications or conversion to open surgery were detected. One patient (8%) required postoperative readmission due to partial bowel obstruction symptoms that required catheterization of the stoma. Pain significantly worsened after the first postoperative day compared to preoperative data but improved after the first postoperative month compared to the first postoperative week and after the 90th postoperative day compared to the first postoperative month, with significant differences. Significant restriction improvement was identified when 30 days after surgery data were compared to preoperative data and when the 180th postoperative day results were compared to 30 days after surgery. The average follow-up was 29 months. During the follow-up no clinical or radiological recurrence was observed. CONCLUSION: This paper shows low rate of intra- and postoperative complications with significant improvement in terms of pain activities restriction compared to preoperatory. After 29 months follow-up, no recurrence was identified, confirming that this approach offers good mid-term results.

Giant pancreatic cystic lymphangioma.

A giant cystic lymphangioma in the pancreatic body-tail was diagnosed as an incidental ultrasound mass in a 41-year-old patient, with a progressive size that had increased in the last year by about 20 cm size. An ultrasound guided fine needle puncture was performed and the result was a benign cystic lesion. Given the increase in size, a surgical intervention was decided. A retroperitoneal cystic tumor dependent on the posterior pancreatic wall was identified and a full laparoscopic resection with pancreas and spleen preservation was performed. The pathological report confirmed the diagnosis of benign cystic lymphangioma. The patient was discharged on the fifth postoperative day without any remarkable complications. After one year of follow-up, the patient remains asymptomatic.

Clip migration after cholecystectomy.

We present the case of a 43-year-old female who underwent cholecystectomy with choledochotomy and laparoscopic lithoextraction for choledocholithiasis, who came to the emergency room due to abdominal pain of 3 days' evolution. An abdominal CT scan showed a possible cholangitis with a liver abscess at the level of segment VI, with metal density material near to the lesion. The inflammatory process extended to the right iliac psoas.

Unusual presentation of obstructive jaundice.

Carcinoid tumors of the ampulla of Vater grow slowly and have an excellent prognosis after complete resection of local disease. Histopathological diagnosis is definitive, and the Whipple's procedure is performed as a standard at the present time, although more novel minimally-invasive techniques may be highly useful for selected patients. While tumor size is not a reliable marker of tumor aggression, it is nonetheless related to lymphatic invasion, hence an accurate diagnosis is important if the patient is to be offered the best option available for the treatment of their disease. Endoscopic ultrasound (EUS) is the technique of choice for presurgical assessment and endocopic excision, as it may rule out vascular and nodal involvement, and establish whether submucosal invasion is present, which precludes endoscopic resection. Local resection has been shown to obtain similar results as compared to CDP in terms of overall survival in patients with small periampullary NETs, with the advantage of significantly lower morbidity in selected cases.

Una forma poco común de presentación de ictericia obstructiva / Unusual presentation of obstructive jaundice

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Linfangioma quístico gigante pancreático

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