Robotic-Assisted Bladder Diverticulectomy: Indications, Technique and Outcomes - a Case Series.

PURPOSE: This case series describes the experience and outcomes of multiple Australian surgeons performing robotic-assisted bladder diverticulectomy (RABD), highlighting the procedural effectiveness and safety, for both benign and malignant indications for diverticulectomy. METHODS: Outcomes were analysed from Thirteen experienced Australian urologists who performed RABD between 2016 and 2023. Retrospective analysis was performed on prospectively collected data which included patient demographics, diverticulum characteristics, surgical approaches, and post-operative outcomes. Surgical techniques included the extravesical and intravesical approaches, with the focus on maintaining oncological principles in cases of malignancy. RESULTS: A total of 28 patients underwent RABD, with the majority being male and a mean age of 63.9 years. All surgeons utilised a four port transperitoneal approach and opted for the extravesical dissection of the diverticular neck, one case utilised both extravesical and a trans-diverticular approach. Functional outcomes demonstrated symptomatic resolution in patients with non-malignant diverticula, while oncological outcomes indicated clear margins in 90% of malignant cases. The average length of the procedure was 106 minutes, with minimal blood loss and a mean hospital stay of 2.67 days. Early complications occurred in 14% with the majority Clavien-Dindo grade II . CONCLUSION: Robotic bladder diverticulectomy, predominantly via the transperitoneal extravesical approach, has emerged as a safe, effective, and reliable surgical intervention for both malignant and non-malignant bladder diverticula. The consistent surgical approach and excellent outcomes demonstrated in this case series reinforce the procedure's potential as a safe option, even in the setting of malignancy within a diverticulum.

Surgical mesh used for an inguinal herniorrhaphy acting as a nidus for a bladder calculus.

We describe an unusual case of surgical mesh used in laparoscopic inguinal herniorrhaphy acting as a nidus for a bladder calculus.

Cholecystectomy in patients with Crohn's ileitis.

PURPOSE: Gallstone disease is reported to be higher in patients with Crohn's disease than in the general population. This study was designed to determine the prevalence of cholecystectomy in patients with Crohn's ileitis, attempt to identify any associated risk factors, and determine whether it is justified to perform prophylactic cholecystectomy during ileocolic resection. METHODS: A total of 191 patients with Crohn's ileitis who were treated medically or who had an ileocolic resection were retrospective reviewed. A questionnaire survey was performed. Telephone interviews were conducted for the non respondents. Further review of medical records was performed to determine the details of admissions for any gallstone disease and/or subsequent cholecystectomy. A control group matched for age and gender was obtained. RESULTS: A total of 191 questionnaires were mailed, and the overall response rate was 70.2 percent (134/191) after telephone interview follow-up. There were 2 of 45 medical and 18 of 89 surgical patients with symptomatic cholelithiasis, i.e., 14.9 percent (20/134) of respondents. As a result, 2 patients (1.5 percent) required endoscopic sphincterotomy, 17 patients (12.7 percent) needed cholecystectomy, and 1 patient (0.7 percent) did not have any intervention. Only five patients had a cholecystectomy after their ileal resections. In the control group of 150 patients, 15 patients (14 females; mean age, 51.9 years; range, 34-78 years) had previous cholecystectomy. There was no significant difference with prevalence of cholecystectomy in Crohn's patients compared with controls (17/134 vs. 15/150; P = not significant). Furthermore, the number of ileal resections did not affect the cholecystectomy rate, but patients who had >30 cm of ileum resected were more likely to have cholecystectomy (P = 0.056). CONCLUSIONS: The prevalence of gallstone disease in Crohn's ileitis requiring cholecystectomy is similar to that of the general population with a female predominance. In addition, the number of patients requiring cholecystectomy after ileal resection was low. Thus, synchronous prophylactic cholecystectomy during ileocolic resection for Crohn's ileitis is not justified.

Small bowel obstruction: is routine colonoscopy necessary after resolution?

BACKGROUND: Small bowel obstruction is common in clinical practice and is most often due to adhesions. The aim of this study was to determine the significance of colon cancer presenting as a small bowel obstruction at a single institution and to find out whether routine colonoscopy was necessary in patients who had spontaneous resolution of their small bowel obstruction. METHODS: A retrospective review of the medical records of patients presenting with small bowel obstruction from 1995 to 2000 at the Prince of Wales Hospital was performed. The clinical outcomes were obtained from the medical records and the clinical notes of each surgical consultant. RESULTS: Over the study period, 251 patients presented with small bowel obstruction. The mean age at presentation was 63.8 years (range 21-95 years). A total of 149 patients (59.4%) were treated conservatively with an average hospital stay of 4.6 days (range 1-20 days). Another 100 patients (39.8%) were treated operatively with a mean time from presentation to operation of 2.2 days (range <24 h-14 days). The remaining two patients (0.8%) were managed palliatively because of known metastatic disease. At laparotomy, 13 patients (13%) had a colon cancer identified. A further three patients were identified to have a colon cancer on follow up colonoscopy. However, only one of the three patients had had a previous laparotomy, that is, only 0.7% (1/149) of patients with a spontaneously resolved small bowel obstruction (presumably secondary to adhesions) had actually had colon cancer. CONCLUSIONS: The overall incidence of small bowel obstruction secondary to colon cancer is significant at 6.4%. However, as the incidence of colon cancer in patients who had had a previous laparotomy and spontaneous resolution of their obstruction was very low at 0.7%, routine colonoscopy does not seem warranted.