Laparoscopic Mobilization of an Omental Flap for a Chronic Scarpa Triangle Suppuration after Vascular Graft Infection.

We report a case of laparoscopic mobilization of an omental flap (left epiploic vessels) which was used to solve a Scarpa triangle chronic suppuration after a vascular prosthesis infection (coverage of bovine pericardium patch angioplasty for closure of the defect resulting after the excision of the vascular graft). The procedure lasted 90 minutes and was performed using 3 trocars and standard laparoscopy instruments. The immediate postoperative course was favourable, with regain of transit after 12 hours and healing of the wound; the patient died 9 months later due to some complications that occurred on the contralateral leg. In cases with a favourable anatomy, the laparoscopic mobilization of the omentum is extremely easy, being associated with a quick recovery and a reduction of the morbidity.

Anatomo-clinical analysis of 14 consecutive cases of primary cystic mesenterico-epiploic tumors.

BACKGROUND: The aim of this study is an anatomo-clinical evaluation of the primary cystic mesenterico-epiploic tumors,based on a single-center's 15 year experience. MATERIAL AND METHOD: We performed a retrospective study of a series of 14 primary cystic mesenterico-epiploic tumors that were operated in the Surgical Department 4 UMPh Targu-Mures, Romania, between 01.01.1997 and 01.01.2012. Data about the clinical complaints, imagistic aspects, associated lesions, surgical approach, hospitalization, pathology, and immediate and late postoperative course were recorded and analysed using the Microsoft Excel software. RESULTS: In all cases we performed a complete and intact surgical excision, using an open approach in 13 cases and laparoscopy in 1 case, with no mortality and no significant surgical-related morbidity; we have encountered a single recurrence at 1.5 years after surgery. We had no preoperative pathological diagnosis; the exact preoperative anatomic location of the tumor was possible only in one case. Pathologic examination showed the following types: inclusion cysts - 4 cases, enteral duplication cysts - 2 cases, simple mesothelialcysts - 6 cases, cystic lymphangioma - 1 case and simple lymphatic cyst - 1 case. We have systematized 3 clinicoimagistic patterns according to the dimension of the tumor,with no relationship to the histologic origin of the tumor. CONCLUSIONS: Primary cystic mesenterico-epiploic tumors aredifficult to diagnose preoperatively. Complete excision is usually possible, even for large tumors. These relatively rare tumors must be considered in the differential diagnosis of cystic abdominal masses.