OV15 EMERGENCY SURGERY OF OBSTRUCTED VENTRAL HERNIA USING TAPP TECHNIQUE: A SAFE AND FEASIBLE APPROACH

Abstract Aim to explain and show the feasibility of laparoscopic TAPP technique in emergency procedures Material and Methods we present a 71-year-old female with personal history of obesity (BMI 32) and a laparoscopic right hemicolectomy performed in 2018, presenting at the ER with a 24-hour intestinal obstruction due to incarcerated ventral incisional hernia. Results laparoscopic reduction of the hernia contents was achieved without need of intestinal resection, prior to access to the preperitoneal space, creating a peritoneal flap that was dissected around the hernia. Following closure of the hernia defect, a polypropylene mesh was placed and the peritoneal flap closed. There were no intraoperative or postoperative events and patient was discharged on 3rd POD. Conclusions laparoscopic approach to emergency hernias in selected patients doesn’t differ from elective surgery, and offers great advantages in terms of evaluation of the incarcerated elements, and postoperative recovery, especially in obese patients where a conventional open approach has higher morbidity.

Download Full-text

P163 ROLE OF THE LAPAROSCOPIC APPROACH IN EMERGENT INGUINAL HERNIA REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab395.152 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Joan Ricard Soler Frias ◽

Anabel García León ◽

Luis Tallon-Aguilar ◽

Jose Tinoco González ◽

Alejandro Sánchez Arteaga ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Elective Surgery ◽

Intestinal Resection ◽

Laparoscopic Approach ◽

Laparoscopic Group ◽

Reoperation Rate ◽

Open Group ◽

Open Approach

Abstract Aim Analyze the evolution of the laparoscopic approach in emergent inguinal hernia repair at our center. Material and Methods Retrospective review of patients with emergent inguinal hernia repair in our center from January 2011 to June 2020. Demographic, clinical and postoperative data were analyzed as well as the evolution of the laparoscopic approach. Results 385 patients with incarcerated/strangulated inguinal hernia were registered. 58.96% were men, with a median age of 71. Of those, 22 patients (5.71%) were treated by laparoscopic approach and 363 (94.29%) by open approach. The open approach had a longer median hospitalization (4.82 vs 1.66 days), higher rate of surgical wound infection (5.51% vs. 0%), higher reoperation rate (3.31% vs 0%) and higher incidence of respiratory complications (1.97% vs 0%). 1 patient (4.54%) with laparoscopic approach required intestinal resection vs 48 patients (13.22%) of the open group, with a dehiscence rate of 0% vs 4.76% respectively. Mortality rate was 0% for the laparoscopic group and 2.75% in the open group. In the last 18 months, 28.98% of urgent hernias repaired have been performed laparoscopically, while previously from 2011 to 2017 only 0.95%, due to the learning curve obtained in elective surgery where the laparoscopic approach has had a major development in the last 3 years. Conclusions Despite the evident patient selection bias because the approach choice by the surgeon in emergent inguinal hernia repair, laparoscopic approach is feasible and has lower morbidity-mortality compared to open approach in our center. In specialized centers this may be a treatment option for selected patient groups.

Download Full-text

Foramen of Winslow hernia: an open approach

International Surgery Journal ◽

10.18203/2349-2902.isj20210982 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1312

Author(s):

Muhammad F. Rosley ◽

Senal Medagedara ◽

Marius Jordaan

Keyword(s):

Epigastric Pain ◽

Intestinal Resection ◽

Laparoscopic Approach ◽

Operative Management ◽

Open Approach ◽

Cross Sectional ◽

Foramen Of Winslow ◽

Internal Hernias ◽

Preventative Measures ◽

The Right

Foramen of Winslow hernia (FWH) are considered rare even among other internal hernias. It was first described in 1834 and historically had a mortality rate of close to 50%. With modern advancement and availability of cross-sectional imaging, this number has improved dramatically to 5%. Operative management is required for all patients which can be performed with either an open or laparoscopic approach. Preventative measures for recurrence remain controversial as no case of recurrence has been reported to date. We present a case study of a 62 years old woman who presented to the emergency department with severe epigastric pain and a CT scan confirming an FWH. She underwent urgent laparotomy and the hernia was easily reducible without need of intestinal resection. We opted to fixate the right colon and close the foramen of Winslow to prevent future recurrence. She recovered from her surgery well and was discharged home without any complications.

Download Full-text

Hot Topics in Surgical Management of Acute Diverticulitiss

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-555 ◽

2020 ◽

Vol 28 ◽

pp. 29-34 ◽

Cited By ~ 1

Author(s):

Gian Andrea Binda ◽

Alfredo Papa ◽

Roberto Persiani ◽

Ricardo Escalante ◽

Enio Chavez De Oliveira ◽

...

Keyword(s):

Surgical Management ◽

Peritoneal Lavage ◽

Elective Surgery ◽

Laparoscopic Approach ◽

Sigmoid Resection ◽

Open Approach ◽

Hartmann Procedure ◽

Elective Resection ◽

Laparoscopic Peritoneal Lavage ◽

Operation Rate

In this session different issues for the surgical management of diverticular disease DD) were considered. The first session debated about the antibiotic treatment for acute uncomplicated diverticulitis (AUD), and supports their use selectively rather than routinely in patients with AUD. The second session discussed the best surgical treatment for those patients. Open approach is a valid choice especially in acute setting, while the laparoscopic approach should be individualised according to the level of skills of the surgeon and the risk factors of the patient (such as obesity and state of health at the time of the operation). The third session debated about the peritoneal lavage and drainage, which is still a safe surgical procedure. However, it requires longer follow-up and results of other trials to draw an adequate conclusion. The last session covers the current surgical certainties in managing complicated DD: 1. urgent colectomy has higher mortality in immune-compromised patients, while in elective surgery is comparable with other populations; 2. laparoscopic peritoneal lavage (LPL) should be the choice in young/fit patients; 3. elective resection is safer in an inflammation free interval; 4. laparoscopic resection shows advantages in several outcomes (such as post-operative morbidity and lower stoma and re-operation rate); 5. in Hinchey III/fecal peritonitis, primary sigmoid resection and anastomosis (open or laparoscopic) could be proposed in young/ fit patient; 6. in case of emergency surgery, Hartmann procedure (open or laparoscopic) must be considered in critically ill/unstable patient.

Download Full-text

Laparoscopic versus Open Complete Mesocolic Excision for Right Colon Cancer

International Journal of Surgical Oncology ◽

10.1155/2021/8859879 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Ali Zedan ◽

Essam Elshiekh ◽

Mohamed I Omar ◽

Mohamad Raafat ◽

Salah M. Khallaf ◽

...

Keyword(s):

Colon Cancer ◽

Laparoscopic Approach ◽

Complete Mesocolic Excision ◽

Right Hemicolectomy ◽

Oncologic Outcomes ◽

Time Interval ◽

Open Approach ◽

Right Colon ◽

Right Colon Cancer ◽

Mesocolic Excision

Background and Objectives. The use of complete mesocolic excision (CME) technique seems to be gaining popularity in the management of cancer colon. We aim to compare the laparoscopic approach for CME with the open approach in right colon cancer treatment with regard to the feasibility, safety, and perioperative and oncologic outcomes. Patients and Methods. A prospective study which included all patients that underwent radical right hemicolectomy for pathologic confirmed stage II or stage III tumor with CME at South Egypt Cancer Institute, Assiut University, from January 2012 to December 2019. Patients were grouped according to the surgical approach into the laparoscopic colectomy (LCME) group (n = 48) or open colectomy (OCME) group (n = 48). Results. The mean operative time was significantly longer in the LCME group than that in the OCME group with less mean intraoperative blood loss. Conversion was required in 4 patients (8.3%) in the LCME group. The use of laparoscopy increased the number of harvested lymph nodes compared to the open approach (39.81 ± 16.74 vs. 32.65 ± 12.28, respectively, P = 0.010 ). The laparoscopic approach was associated with a shorter time interval to first flatus as well as shorter time interval to liquid and normal diet after surgery. The postoperative hospital stay was significantly shorter in the LCME group. The complication rate was slightly lower in the LCME (14.7%) than in the OCME group (27.2%) ( P = 0.252 ). The 3-year OS in the LCME group was similar to that in OCME (78.2% vs. 63.2%, respectively, P value = 0.423). The three-year DFS in the laparoscopic group was higher (74.5%) than the open group (60.0%), but did not reach statistical significance ( P value = 0.266). Conclusions. In conclusion, laparoscopic CME right hemicolectomy is a technically feasible and safe procedure if surgeon expertise is present. LCME has long-term oncologic outcomes (recurrence and survival) comparable to open surgery for management of patients with stage II or III colon cancer.

Download Full-text

Transverse colonic volvulus due to mesenteric fibromatosis: a case report

BMC Gastroenterology ◽

10.1186/s12876-020-01592-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Akihiro Yoshida ◽

Yasutake Uchima ◽

Naoki Hosaka ◽

Kosuke Minaga ◽

Masatoshi Kudo

Keyword(s):

Transverse Colon ◽

Colonic Neoplasms ◽

Right Hemicolectomy ◽

Large Bowel Obstruction ◽

Postoperative Recovery ◽

Thyroid Tumor ◽

Hepatic Flexure ◽

Colonic Volvulus ◽

Mesenteric Fibromatosis ◽

Histopathological Results

Abstract Background Colonic volvulus, a condition in which a colonic segment partially twists around its base, is the third leading cause of large bowel obstruction after colonic neoplasms and diverticular disease. However, volvulus of the transverse colon is the rarest type of large intestinal volvulus. Moreover, the occurrence of transverse colonic volvulus secondary to a benign tumor originating from outside the intestine has never been reported. We hereby report a case of transverse colonic volvulus caused by mesenteric fibromatosis. Case presentation A 53-year-old female with a history of rheumatoid arthritis and thyroid tumor presented with abdominal pain for 1 day. Abdominal computed tomography revealed intestinal torsion at the hepatic flexure. Twisted and obstructed mucosa of the transverse colon was observed during colonoscopy, but no tumor invasion of the mucosal surface was detected. A solid mass of a mesenteric origin with involvement of the transverse colon was observed during surgery. The mass was diagnosed surgically as transverse colonic volvulus induced by a mesenteric tumor. Hence, the patient underwent a right hemicolectomy. Histopathological results indicated mesenteric desmoid-type fibromatosis. The postoperative recovery was uneventful, and the patient was discharged 8 days after surgery. Conclusions Although mesenteric fibromatosis is rare, this disease should be considered when managing transverse colonic volvulus resulting from nonmucosal tumors.

Download Full-text

THREE CASES OF BOWEL OBSTRUCTION BY BROAD LIGAMENT HERNIA

British Journal of Surgery ◽

10.1093/bjs/znab160.017 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

M Soto Dopazo ◽

E Pérez Prudencio ◽

A Arango Bravo ◽

C Nuño Iglesias ◽

C Mateos Palacios ◽

...

Keyword(s):

Small Bowel ◽

Bowel Obstruction ◽

Broad Ligament ◽

Intestinal Resection ◽

Laparoscopic Approach ◽

Exploratory Laparotomy ◽

X Rays ◽

Intestinal Necrosis ◽

Urgent Surgery ◽

Internal Hernias

Abstract INTRODUCTION Internal hernias caused by broad ligament defects are an infrequent cause of bowel obstruction. These defects may be congenital or acquired mainly by gynecological antecedents. Small bowel is the most common affected and the diagnosis is difficult due to nonspecific symptoms and absences of characteristic radiological signs. MATERIAL AND METHODS We report the cases of three women aged from 43 to 56 years old, who came to the emergency with abdominal pain, vomiting and bloating of hours duration. One patient has a history of laparoscopic appendectomy, the rest of them with no surgical history. In all of the cases, x-rays showed dilatation of small bowel loops and air-fluid levels and the abdominal TC revealed a generalized distention of bowel loops with transition point in the terminal ileum with no identifiable cause compatible with small bowel obstruction. RESULTS We decided to perform an urgent surgery with an exploratory laparotomy in one case and the rest by laparoscopic approach, finding an internal hernia occasioned by incarceration of small bowel through a broad ligament defect. In all cases, the hernia content was liberated without evidence of ischemia with no need for intestinal resection, and the defect was closed. All patients had a favourable postoperative course without complications. DISCUSSION Broad ligament defects are a rare cause of internal hernias. These are difficult to diagnose clinically as well as radiologically for an absence of characteristic signs. A high level of clinical suspicion allows early diagnosis and the treatment should be performed as soon as possible to reduce the chances of intestinal necrosis.

Download Full-text

Non-medical risk factors associated with postponing elective surgery: a prospective observational study

BMC Medical Ethics ◽

10.1186/s12910-021-00660-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Julia Becker ◽

Gerald Huschak ◽

Hannes-Caspar Petzold ◽

Volker Thieme ◽

Sebastian Stehr ◽

...

Keyword(s):

Elderly Patients ◽

Low Socioeconomic Status ◽

Elective Surgery ◽

Nursing Home Residents ◽

Hospital Staff ◽

Data Management System ◽

Electronic Patient Records ◽

Specific Patient ◽

Emergency Procedures ◽

Patient Groups

Abstract Background Operation room (OR) planning is a complex process, especially in large hospitals with high rates of unplanned emergency procedures. Postponing elective surgery in order to provide capacity for emergency operations is inevitable at times. Elderly patients, residents of nursing homes, women, patients with low socioeconomic status and ethnic minorities are at risk for undertreatment in other contexts, as suggested by reports in the medical literature. We hypothesized that specific patient groups could be at higher risk for having their elective surgery rescheduled for non-medical reasons. Methods In this single center, prospective observational trial, we analysed 2519 patients undergoing elective surgery from October 2018 to May 2019. A 14-item questionnaire was handed out to illicit patient details. Additional characteristics were collected using electronic patient records. Information on the timely performance of the scheduled surgery was obtained using the OR’s patient data management system. 6.45% of all planned procedures analysed were postponed. Association of specific variables with postponement rates were analysed using the Mann–Whitney U test and Fisher's exact test/χ2-test. Results Significantly higher rates of postponing elective surgery were found in elderly patients. No significant differences in postponing rates were found for the variables gender, nationality (Germany, EU, non-EU), native language, professional medical background and level of education. Significantly lower rescheduling rates were found in patients with ties to hospital staff and in patients with a private health insurer. Conclusions Elderly patients, retirees and nursing home residents seem to be at higher risk for having their elective surgery rescheduled. However, owing to the study design, causality could not be proven. Our findings raise concern about possible undertreatment of these patient groups and provide data on short-term postponement of elective surgery. Trial registration DRKS00015836. Retrospectively registered.

Download Full-text

Continuous Preperitoneal Infusion of Ropivacaine Provides Effective Analgesia and Accelerates Recovery after Colorectal Surgery

Anesthesiology ◽

10.1097/01.anes.0000278903.91986.19 ◽

2007 ◽

Vol 107 (3) ◽

pp. 461-468 ◽

Cited By ~ 200

Author(s):

Marc Beaussier ◽

Hanna El’Ayoubi ◽

Eduardo Schiffer ◽

Maxime Rollin ◽

Yann Parc ◽

...

Keyword(s):

Pain Relief ◽

Colorectal Resection ◽

Controlled Trial ◽

Plasma Concentrations ◽

Postoperative Recovery ◽

Morphine Consumption ◽

Major Surgery ◽

Preperitoneal Space ◽

Wound Infiltration ◽

Open Colorectal Resection

Background Blockade of parietal nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a multimodal approach to postoperative pain management after major surgery. The role of continuous preperitoneal infusion of ropivacaine for pain relief and postoperative recovery after open colorectal resections was evaluated in a randomized, double-blinded, placebo-controlled trial. Methods After obtaining written informed consents, a multiholed wound catheter was placed by the surgeon in the preperitoneal space at the end of surgery in patients scheduled to undergo elective open colorectal resection by midline incision. They were thereafter randomly assigned to receive through the catheter either 0.2% ropivacaine (10-ml bolus followed by an infusion of 10 ml/h during 48 h) or the same protocol with 0.9% NaCl. In addition, all patients received patient-controlled intravenous morphine analgesia. Results Twenty-one patients were evaluated in each group. Compared with preperitoneal saline, ropivacaine infusion reduced morphine consumption during the first 72 h and improved pain relief at rest during 12 h and while coughing during 48 h. Sleep quality was also better during the first two postoperative nights. Time to recovery of bowel function (74 +/- 19 vs. 105 +/- 54 h; P = 0.02) and duration of hospital stay (115 +/- 25 vs. 147 +/- 53 h; P = 0.02) were significantly reduced in the ropivacaine group. Ropivacaine plasma concentrations remained below the level of toxicity. No side effects were observed. Conclusions Continuous preperitoneal administration of 0.2% ropivacaine at 10 ml/h during 48 h after open colorectal resection reduced morphine consumption, improved pain relief, and accelerated postoperative recovery.

Download Full-text

Comparative study of inflammatory response and adhesions formation after fixation of different meshes for inguinal hernia repair in rabbits

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502005000500002 ◽

2005 ◽

Vol 20 (5) ◽

pp. 347-352 ◽

Cited By ~ 30

Author(s):

Alberto Goldenberg ◽

Jacques Matone ◽

Wagner Marcondes ◽

Fernando Augusto Mardiros Herbella ◽

José Francisco de Mattos Farah

Keyword(s):

Inflammatory Response ◽

Abdominal Wall ◽

Peritoneal Cavity ◽

Abdominal Cavity ◽

Mesh Fixation ◽

Rabbit Model ◽

Laparoscopic Approach ◽

Preperitoneal Space ◽

Similar Amount ◽

The Right

PURPOSE: Compare, in a rabbit model, the inflammatory response and adhesions formation following surgical fixation of polypropilene and Vypro mesh in the inguinal preperitoneal space. METHODS: Fourteen male New Zealand rabbits, weighing between 2.000 to 2.500 g were used. A midline incision was made and the peritoneal cavity was exposed. The 2,0X1,0 cm polypropylene mesh was fixed in the left flank and secured to the margins with 3-0 prolene in a separate pattern. In the right flank, a 2,0X1,0 cm Vypro II mesh was sewn in the same way. After the post surgical period, the animals were again anesthetized and underwent laparoscopic approach, in order to identify and evaluate adhesions degree. Both fixed prosthesis were excised bilaterally with the abdominal wall segment, including peritoneum, aponeurosis and muscle and sent to a pathologist RESULTS: Operative time ranged from 15 to 25 minutes and no difficulties in applying the mesh were found. From the 14 polypropylene meshes fixed to the intact peritoneum, 11 had adhesions to the abdominal cavity (78,6%). Concerning Vypro mesh, 12 animals developed adhesions from the 14 with mesh fixation (85,7%). Histological examination of tissues harvested revealed fibroblasts, collagen, macrophages and lymphocytes between the threads of the mesh. CONCLUSION: Polypropylene and Vypro mesh, when implanted in the peritoneal cavity of rabbits provoke similar amount of adhesions. Vypro mesh tissues had higher fibrosis resulting in better mesh incorporation to the abdominal wall.

Download Full-text

Redo Surgery after Failure of Antireflux Surgery

The American Surgeon ◽

10.1177/000313481808401142 ◽

2018 ◽

Vol 84 (11) ◽

pp. 1819-1824 ◽

Cited By ~ 3

Author(s):

Alberto Vilar ◽

Pablo Priego ◽

Ana Puerta ◽

Marta Cuadrado ◽

Francisco GarcÍA Angarita ◽

...

Keyword(s):

Hiatal Hernia ◽

Laparoscopic Approach ◽

Long Term Results ◽

Complication Rates ◽

Open Approach ◽

Redo Surgery ◽

Primary Surgery ◽

Satisfactory Outcome ◽

Symptomatic Outcome ◽

Recurrent Hiatal Hernia

Surgery for refractory gastroesophageal reflux disease (GERD) has a satisfactory outcome for most patients; however, sometimes redo surgery is required. The Outcome and morbidity of a redo are suggested to be less successful than those of primary surgery. The aim of this study was to describe our experience, long-term results, and complications in redo surgery. From 2000 to 2016, 765 patients were operated on for GERD at our hospital. A retrospective analysis of 56 patients (7.3%) who underwent redo surgery was conducted. Large symptomatic recurrent hiatal hernia (50%) and dysphagia (28.6%) were the most frequent indications for redo. An open approach was chosen in 64.5 per cent of patients. Intraoperative and postoperative complication rates were 18 per cent and 14.3 per cent, respectively. Mortality rate was 1.8 per cent. Symptomatic outcome was successful in 71.3 per cent. Patients reoperated because of dysphagia and large recurrent hiatal hernia had a significantly higher failure rate (32.3% and 31.2%, respectively; P = 0.001). Complication rate was significantly lower in the laparoscopic group (0% vs 22.2%; P = 0.04). There were no statistical differences between expert and nonexpert surgeons. Laparoscopic approach has increased to 83.3 per cent in the last five years. Symptomatic outcome after redo surgery was less satisfactory than that after primary surgery. Complications were lower if a minimally invasive surgical approach was used.

Download Full-text