Splenosis mimicking gastric obstructive tumor: Diagnostic workup and surgical excision.

Splenosis is a condition that occurs after splenic rupture. A 29-year-old male patient with a history of splenectomy was admitted due to multiple vomiting episodes. The diagnostic workup was unable to differentiate between gastric GIST and splenosis. Laparoscopic surgical resection was performed leading to the diagnosis of splenosis.

The impact of laparoscopic sleeve gastrectomy on weight loss and obesity-associated comorbidities: the results of 3 years of follow-up.

BACKGROUND: Laparoscopic sleeve gastrectomy is one of the most recent advances in the surgical treatment of morbid obesity. Extended follow-up studies of large cohorts are needed to establish the usefulness of the operation. The objectives of this study are to delineate the role of sleeve gastrectomy in weight loss and in comorbidities among obese patients. METHODS: Patients who underwent laparoscopic sleeve gastrectomy in a single bariatric center were followed up for a 3-year period. Weight loss and status of several comorbidities were assessed at the 1st, 3rd, 6th, 12th, 18th, 24(th), and 36th postoperative month. RESULTS: Overall, after 3 years of follow-up of 88 patients, the mean body mass index (BMI) of the patients was 29.8 kg/m(2) (SD ±6.1), the % total weight loss was 38.1% (SD ±12.9), the % excess weight loss was 69.5% (SD ±17.5), and the % estimated BMI loss was 81.4% (SD ±22.3). These parameters changed significantly over the first year of follow-up (p < 0.001) and subsequently stabilized. The percentages of patients with hypertension (33.3%), hyperlipidemia (26.4%), diabetes mellitus (20.7%), obstructive sleep apnea (20.2%), and gastroesophageal reflux disease (GERD-27%) were significantly reduced (10.5, 9.2, 1.1, 1.1, and 9.2% respectively at 36 months postoperation), while 10 new cases of GERD appeared postoperatively. However, only three of the new GERD cases required medication, and only one of them experienced symptoms that persisted after the 3-year period. CONCLUSION: Three years of close follow-up of patients who had undergone laparoscopic sleeve gastrectomy demonstrated satisfactory weight loss results. Promising results were also obtained regarding various comorbidities of obese patients. Longer follow-up studies for more patients are needed to delineate the exact role of sleeve gastrectomy on postoperative outcomes.

Impact of Laparoscopic Sleeve Gastrectomy on Weight Loss and Associated Comorbidities in Adolescents and Young Adults.

BACKGROUND: Obesity is a common disease affecting young adults and adolescents worldwide. This study aims to delineate the role of laparoscopic sleeve gastrectomy (LSG) in weight loss and associated comorbidities to adolescents and young adults. PATIENTS AND METHODS: This study is a retrospective analysis of a prospective cohort of all young adults 16-22 years old who underwent LSG for morbid obesity and were followed up for 24 months. Demographic data, weight loss, and the status of several comorbidities, such as diabetes mellitus, hypertension, and dyslipidemia, were assessed at postoperative Months 1, 3, 6, 12, 18, and 24. RESULTS: Overall, at baseline and after 24 months of close follow-up of 37 adolescents and young adults who had undergone LSG, the body mass index of the patients was 46.93 ± 6.07 kg/m(2) versus 26.2 ± 3.6 kg/m(2) (P < .001), and the body weight was 143 ± 29 kg versus 78 ± 15 kg (P < .001). From the first follow-up visit after operation to the last one at the 24 months, there was also a significant difference in percentage excess weight loss (22.40 ± 6.58% versus 81 ± 17%; P < .001), body mass index difference (-5.47 ± 1.69 kg/m(2) versus -18.08 ± 4.38 kg/m(2); P < .001), and percentage excess body mass index loss (26.06 ± 7.56% versus 96 ± 21%; P < .001). The percentage of the adolescents and young adults with diabetes mellitus, hypertension, and dyslipidemia were diminished gradually at 6 months postoperatively (P < .001). CONCLUSIONS: LSG represents a safe and attractive treatment strategy for morbidly obese adolescents and young adults with comorbidities. In this study group excellent resolution of excess weight and comorbid conditions is achieved 2 years after LSG.

Treating peritoneal mesothelioma with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A case series and review of the literature.

BACKGROUND: Encouraging results on survival of patients with malignant peritoneal mesothelioma have been shown with the use of cytoreductive surgery and perioperative intraperitoneal chemotherapy. This study explores the impact of aggressive surgical treatment on overall survival of peritoneal mesothelioma. METHODS: This is a retrospective analysis of prospectively collected clinical data of all patients with diagnosis of malignant peritoneal mesothelioma treated in a designated referral centre in Greece. All patients were offered cytoreductive surgery and intraperitoneal chemotherapy. Patient's characteristics, operative reports, pathology reports, and discharge summaries were stored in an electronic database and later reviewed and analysed. RESULTS: Cytoreduction for peritoneal mesothelioma was performed on 20 patients (15 men and 5 women) with a mean age of 59.4 years (SD 16.1). Mean peritoneal cancer index was 16.1 (SD 10.4) and the median completeness of cytoreduction score was 2 (range 1-2). Mean overall survival was 46.8 months (SE 4.03) with a mean of 21.4 and median of 18 months of follow-up. Disease-specific survival was 100% for the observed period. Univariate analysis showed the completeness of cytoreduction as the only possible predictor of survival. A median of 10 (range 4-14) peritonectomy procedures were performed per patient. Median hospital stay was 14 (range 10-57 days). Grade III and IV complications occurred post-operatively in 5 patients (25%). Two patients died in the post-operative period of pulmonary embolism and myocardial infarction. CONCLUSION: Cytoreductive surgery with HIPEC has proved the most effective treatment even when taking account of the cost of significant morbidity.

Staple Line Reinforcement with Stitch in Laparoscopic Sleeve Gastrectomies. Is It Useful or Harmful?

BACKGROUND: Reinforcement of the staple line in laparoscopic sleeve gastrectomy (LSG) is a practice that leads to less morbidity, but equivocal results have been reported in the literature. MATERIALS AND METHODS: This is a prospective randomized study comparing two groups of patients who underwent LSG. In one group LSG was performed with a running absorbable suture placement at the staple line. In the other group the running suture was not placed. General data of the patients, as well as intraoperative and postoperative data, were gathered and statistically analyzed. RESULTS: Overall, 146 patients were subjected to LSG. In 84 patients a running suture was placed, and in 62 patients no suture was placed. No significant differences were found between the two groups in demographic data. No significant differences were found also in the intraoperative data, such as number of trocars, number and type of cartridges, drain placement, and operative time (45±21 versus 40±20 minutes, respectively; P<.05). Intraoperative complications were significantly more in the group with the suture placement (33.3% versus 16.1%, respectively; P<.05). Hematomas developed intraoperatively in more patients after the placement of the running suture (9.5% versus 0.0%, respectively; P<.05). Postoperatively, there was no significant difference in morbidity between the two groups (8.3% versus 9.7%, respectively; P>.05). CONCLUSIONS: After this randomized study, final conclusions about the efficacy of this running suture to the staple line cannot be made. To the contrary, problems seem to exist after such reinforcement of the staple line, such as hematomas. Dealing with possible leaks and hemorrhage of the staple line is also problematic after placement of the running suture.

Using Ligasure™ or Harmonic Ace® in Laparoscopic Sleeve Gastrectomies? A Prospective Randomized Study.

BACKGROUND: Laparoscopic sleeve gastrectomy is one of the most recent advances of surgery for treating morbid obesity. Many laparoscopic devices have evolved to provide vascular control and tissue dissection. METHODS: This is a prospective randomized study comparing the intraoperative and postoperative complications and operative time of two groups of patients who underwent laparoscopic sleeve gastrectomy. In the first group after randomization, sleeve gastrectomy was performed using Ligasure™ and in the second group Harmonic Ace® was used. RESULTS: In total, 94 patients were enrolled in the study allocated in two groups. In group 1, 43 patients were operated using Ligasure™, and in group 2, 51 patients were operated using Harmonic Ace®. No significant differences were highlighted between these two groups with regards to operative time (45.0 ± 15.0 vs 40.0 ± 20.0 min, p = 0.199), intraoperative complications (32.6 vs 15.7 %, p = 0.054) and postoperative complications (4.7 vs 17.6 %, p = 0.051). CONCLUSIONS: Both Ligasure™ and Harmonic Ace® provide surgeons ergonomy, and no significant differences were shown in operative time and complications. Safety and efficacy in such demanding operations is of critical importance. Choice between these two shears lies with surgeon's preference.

Laparoscopic excision of a lymphangioma of the cystic duct.

Lymphangiomas are benign tumors that originate from malformations of the lymphatic vessels. They are rarely seen in adults and are extremely rare in the cystic duct. Herein, we report the case of a 48-year-old woman who presented with a cystic lymphangioma that originated in the cystic duct and was excised laparoscopically. Preoperative imaging revealed the cystic and benign nature of the lesion. Laparoscopic abdominal exploration and excision of the 10-cm cystic lymphangioma were performed. Four trocar sites were used, and the excision was achieved using clips and electrocautery. The laparoscopic excision of these benign masses is safe and efficacious in experienced hands. This procedure requires preoperative planning and must be individualized.

Submucosal anoderm-preserving hemorrhoidectomy revisited: a modified technique for the surgical management of hemorrhoidal crisis.

Submucosal hemorrhoidectomy (Parks' procedure) is a recognized method for treating acute hemorrhoidal crisis. Anoderm preservation has been stressed in various techniques described for elective or emergency excisional hemorrhoidal management. Mucopexy techniques have been proven useful as an adjunct to minimally resectional techniques. A modified submucosal technique with anoderm preservation and mucopexy was applied to 45 patients who presented on an emergency basis with hemorrhoidal crisis. External piles were minimally removed, the minimum possible amount of diseased mucosa was excised, a linear incision was used at the anoderm to enter the subanodermal/mucosal plane to achieve the submucosal excision, and a mucopexy was added at the approximation of the mucosal flaps. Postoperative morbidity was minimal and pain after the procedure remained at acceptable levels. This technique allows for an excision limited to the pathology with important anatomic tissue preservation. This results in conservation of the sensitive and useful anoderm, a decreased risk of stenosis, and addresses the mucosal prolapse. The level of postoperative pain with this technique is acceptable and long-term follow-up reveals a high degree of patient satisfaction.

Laparoscopic repair of giant paraesophageal hernia with synthetic mesh: 45 consecutive cases.

Giant paraesophageal hernias (PEHs) are associated with progression of symptoms in up to 45 per cent of patients. Recently, many series have reported that laparoscopic repair of PEH is technically feasible, effective, and safe. A retrospective review of the University of Athens tertiary care hospitals patient database and the patient medical records identified 45 patients who underwent elective repair of a giant PEH between 2002 and 2009. Elective laparoscopic repair of a giant PEH was attempted in 45 patients who were treated with Gore-Tex dual mesh with or without Nissen fundoplication. They all had a mesh repair. Intraoperative complications included one pulmonary embolism and one recurrent hernia. The use of a mesh seems to be effective in the treatment of large hernias. It appears to offer the benefit of a shorter hospital stay and a quicker recovery.