How to do a combined endoscopic and tailored open extraperitoneal approach for large congenital inguinoscrotal hernia

Abstract Background A congenital prepubic sinus (CPS) is a rare congenital anomaly in which a duct remnant extends from the skin opening near the pubic symphysis to various parts and the lesions are mostly located in the preperitoneal space. The totally extraperitoneal (TEP) approach is an operational method that provides a good field of view for the preperitoneal space. We report the CPS through the pubic symphysis in which complete resection was achieved by a TEP approach. TEP approach was minimally invasive and achieved satisfactory cosmetic outcome. Case presentation We herein report the case of a 13-year-old boy with a fistula opening near the dorsal penis. He was admitted to our hospital due to fever and lower abdominal pain. Abdominal ultrasonography and computed tomography revealed an abscess inside a fistula lumen on the posterior surface of the rectus abdominis muscles in the midline of the lower abdomen. Under a diagnosis of CPS, which was located in the preperitoneal space, endoscopic resection was performed by a totally extraperitoneal approach. After making an umbilical incision, the rectus abdominis muscle was excised outward to expose the preperitoneal space. A single-port system was placed in the preperitoneal space. Three 5-mm-port trocars were inserted. As the preperitoneal cavity was expanded, a sinus connecting to the pubic symphysis was confirmed. The pubic symphysis did not connect with the bladder. Because the fistula was penetrated with the pubic symphysis, the remaining caudal fistula was removed from the body surface with a small spindle-shaped incision around the fistula opening. Finally, the sinus was completely resected, with confirmation from both the cranial side and dorsal side of the pubic symphysis. We were able to perform complete resection of the CPS with good visibility and without any peritoneal damage. There were no intraoperative complications. His postoperative course was uneventful during the 1-year follow-up. Conclusions The TEP approach may be feasible for the resection of a CPS and may allow safe and secure resection due to good visibility, even in pediatric patients.

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Right extraperitoneal approach for laparoscopic paracaval bulky lymph node dissection for endometrial cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2021-002421 ◽

2021 ◽

pp. ijgc-2021-002421

Author(s):

Sergey Skugarev ◽

Igor Nikolaev ◽

Igor Kudryavtsev ◽

Alexey Shevchuk

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

Node Dissection ◽

Extraperitoneal Approach

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L'uretere retrocavale: Embriogenesi e correzione laparoscopica con accesso retroperitoneale in un caso ad ansa bassa

Urologia Journal ◽

10.1177/039156039706401s03 ◽

1997 ◽

Vol 64 (1_suppl) ◽

pp. 18-22

Author(s):

C. Trombetta ◽

G. Savoca ◽

G. Liguori ◽

M. Raber ◽

A. Lissiani ◽

...

Keyword(s):

Operating Time ◽

Oral Intake ◽

Operation Time ◽

Ureteral Stent ◽

Surgical Wound ◽

Extraperitoneal Approach ◽

Intravenous Urogram ◽

Minimal Morbidity ◽

Urologic Surgery ◽

Laparoscopic Techniques

With the minimal morbidity attained using laparoscopy, its application in urologic surgery has been increasing. Using laparoscopic techniques we successfully completed the transposition and re-anastomosis of a retrocaval right ureter. Operation time was 240 minutes. The patient was allowed to walk on the first post-operative day and resumed oral intake on the second day. Administration of analgesics was not required. The ureteral stent was removed on the 24th day after operation. An intravenous urogram three months after operation showed a decrease in hydronephrosis. Laparoscopic correction of retrocaval ureter by extraperitoneal approach is a safe, feasible technique, avoiding a large surgical wound with the definite advantage of minimal disfigurement. Operating time is considerably shorter compared to the peritoneal approach as described by Baba (240’ vs 560’).

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Bladder Cancer in an Inguinoscrotal Vesical Hernia

Case Reports in Oncological Medicine ◽

10.1155/2012/142351 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Lucas Regis ◽

Fernando Lozano ◽

Jacques Planas ◽

Juan Morote

Keyword(s):

Adjuvant Radiotherapy ◽

Bladder Tumor ◽

Resection Margin ◽

Diagnostic Delay ◽

Subsequent Treatment ◽

Pathology Report ◽

Inguinoscrotal Hernia ◽

Bladder Dome ◽

Open Surgical Treatment ◽

Anatomical Pathology

We present the case of a 79-year-old male who, due to hematuria, underwent cystoscopy that showed a lesion in the bladder dome. Transurethral resection was attempted, but access to the tumor by this route was impossible. Given the findings, a body CT scan was performed showing an inguinoscrotal hernia with vesical carcinoma contained. Open surgical treatment of the vesical carcinoma contained within the inguinoscrotal hernia was performed in conjunction with the hernia repair. The anatomical pathology report confirmed a high-grade urothelial carcinoma (stage pT2b) with a free resection margin of <1 mm. Adjuvant radiotherapy was selected for subsequent treatment. The presence of bladder tumor in an inguinoscrotal hernia is an uncommon finding and a diagnostic delay can be assumed. The initial therapeutic plan may need to be changed from the usual approaches due to the atypical presentation.

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