“Complex” hepatic echinococcosis

Aim. To study the long-term results of surgical treatment in patients with “complex” hepatic echinococcosis.Materials and methods. The results of surgical treatment of 118 patients with hepatic echinococcosis from 2015 to 2020 at the A.V. Vishnevsky National Medical Research Center of Surgery were analyzed. The term “complex” hepatic echinococcosis has been proposed. A comparative analysis of the number and type of complications and surgical interferences 2 groups of patients was carried out: 66 patients with hepatic echinococcosis, 52 patients with complex hepatic echinococcosis.Results. During the observation period, no any recurrence was recorded. 55 (44%) of 118 patients had complex hepatic echinococcosis. Isolated liver damage was found in 74% of cases, combined liver and lung damage in 20% cases and with other organs – in 6%. In most cases, pericystectomy was performed (82%), 8% of patients underwent atypical hepatectomy, 4% – segmental resection, 3% – laparoscopic intervention, 3% – hemihepatectomy. Postoperative complications were recorded in 22 (18,6%) of cases. Accumulations of bile and biliary fistulas formed in 45% of cases, pneumotothorax or hydrothorax – in 23%, wound abscess – in 18%, hematomas in the hepatectomy zone – in 14% of the cases.Conclusion. Surgical treatment of complex hepatic echinococcosis requires an individual approach to the choice of the operation option. Preference should be given to parenchyma-preserving radical operations. When the liver lobe is totally replaced with a hydatid cyst and in case of cystobiliary fistulas hemihepatectomy should be performed, and it is acceptable to leave the fibrous capsule on large tubular structures.

Laparoscopic removal of a large pheochromocytoma-paraganglioma of the Zuckerkandl organ

Paragangliomas represent 15 to 20% of all chromaffin tissue tumors. Most often, paragangliomas are located in the abdominal cavity along the large vessels — in the para-aortic region from the diaphragm to the aortic bifurcation. One of the most common extra-adrenal pheochromocytomas is the Zuckerkandl tumor, originating from the para-aortic accumulation of sympathetic tissue located in the area of the inferior mesenteric artery’s origine or in the zone of the aortic bifurcation itself. Due to the technical difficulty in performing laparoscopic removal of paragangliomas, conversion to laparotomy is frequent and reaches 80%. The article describes a clinical case of a patient suffering from this type of neoplasm, with diagnosis details and treatment by a successful radical laparoscopic intervention with a large chromaffinnoma located in a difficult anatomical zone removal.

Laparoscopy in management of surgical causes of acute verses chronic pain abdomen in adults visiting tertiary care hospital in Telangana, India

Background: Pain abdomen accounts for about 14.2% of all emergency hospitalization. Many patients remain undiagnosed even after excluding the common disorders by meticulous investigations. In case of diagnostic uncertainty, laparoscopy may help to avoid unnecessary laparotomy, provide accurate diagnosis. The current study aimed at comparing the role of laparoscopy in management of surgical causes of acute and chronic pain abdomen.Methods: A prospective study was done in 168 adult patients attending tertiary care hospital, selected by convenience sampling method. After clinical examination and relevant investigation, patients in need of diagnostic and therapeutic laparoscopic management were included in study. Laparoscopic findings and postoperative status of patients, with acute and chronic pain abdomen were compared with relevant statistical tests.Results: Mean age of patients was 35.8 years. Majority of the patients were females (58.3%). 41.1% and 58.9% patients had acute and chronic pain abdomen, respectively. Though more patients with chronic pain abdomen (58.9%) underwent laparoscopy when compared with acute pain abdomen (41.1%) it was not statistically significant, also post-operative status though found to be better in patients with chronic pain abdomen was not statistically significant.Conclusions: Though prevalence of laparoscopic intervention and better outcome was found more in patients with chronic abdominal pain in the present study it was not statistically significant.

Laparoscopic management of misplaced ureteral double J stent into a left branch of duplicated inferior vena cava

Introduction: Double J Stent is frequently used to preserve urine flow to the kidney in urolithiasis. Migration of double J stent is highly reported in literature. Duplicated inferior Vena Cava is a rare entity that is asymptomatic and usually incidentally diagnosed. Case Presentation: A case of a 46 years old male patient known for multiple episodes of kidney stones presenting for left urolithiasis with hydroureteronephrosis and have underwent a double J stent insertion without fluoroscopic guidance and was discharged home uneventfully, while he returns again for left flank pain. He was diagnosed with Double J stent mispositioning into a duplicated left inferior vena cava. Therefore, a laparoscopic intervention was done to extract the stent and replace it with a new one simultaneously with repair of both the ureter and the vein. Conclusion: Duplicated inferior vena cava is an uncommon finding that has a lot of complications. This is the first reported migration of double J stent into a duplicated inferior vena cava that was Laparoscopically repaired. Keywords: Ureteral stone; Computed tomography scan; Double J stent migration; Duplicated inferior vena cava

A COMPREHENSIVE STUDY ON THE ROLE OF LAPAROSCOPY IN ABDOMINAL TRAUMA

Explorative laparotomy has been the mainstay of management in patients with blunt abdominal trauma . The advantage of laparoscopy is that it can provide both diagnostic and therapeutic interventions for those hemodynamically stable abdominal trauma patients. Methods: 30 patients of blunt trauma abdomen were retrospectively studied for whom laparoscopic intervention was done. Results: In our study 30 patients with abdominal trauma were included of which 22 (76%) had penetrating trauma and 8 had blunt trauma (24%). Among penetrating trauma, seven patients (31.8%) underwent therapeutic laparoscopy whereas diagnostic laparoscopy was done for 10 patients (45.5%). Conclusions: Laparoscopy can be safely performed in haemodynamically stable patients of abdominal trauma for both diagnostic and therapeutic purposes and can help in avoiding the negative laparotomies.

Methods of simultaneous laparoscopic treatment of gallstone disease with inguinal hernia and their effectiveness

Annotation. Aim of work – to define and evaluate visualization and ergonomics during single laparoscopic operations and simultaneous laparoscopic operations for gallstone disease and inguinal hernia. Identify the advantages and disadvantages of techniques. Assess whether our method affects ergonomics during surgery. The design of the study formed as retrospective comparative study with the control and research groups was used for evaluation and analysis. To form groups, a statistical database was used, which included 411 patients treated in VRSH MISD. Ergonomic parameters were analyzed and compared, such as the distance between the surgeon's hands, deviations depending on the patient's physique, the angle between the manipulators, the distance of approach to the target. Null hypothesis technique used, Pearson analysis, Tukey, Mann-Whitney. It is established that the angle between the main working tools 68.64±4.68o [64–73o] against 57.29±6.764o [44–65o] (p <0.001); the visualization area was 12.17±4.43 cm2 against 9.54±2.27 cm2 (p<0.001*); in the first and second groups, respectively; the average distance of the laparoscope approaching the operating area is greater when using a laparoscope with a 30o – viewing angle which is 3.84±0.37 cm [3.4–4.2] and 3.34±0.728 cm [2.5–4.5] for our own and French methods 3.21±0.24 cm [3.0–3.5] vs. 3.41±0.478 cm [2.7–4.1] at an angle of 0o). Performing a simultaneous laparoscopic intervention does not have any significant effect on the imaging and ergonomics during surgery. The technique allows to perform surgical treatment of inguinal hernia and cholecystolithiasis at one time without worsening of ergonomics. The technique found out in VRSH MISD is sufficiently effective and usable.

Operative approach to intestinal malrotation encountered during laparoscopic gastric bypass

Congenital anomalies of midgut rotation are uncommon with a 0.2–0.5% incidence. Intestinal malrotation (IM) presents a unique challenge in bariatric surgery during laparoscopic gastric bypass (LRYGB), and familiarity with alternatives allows for safe laparoscopic intervention. IM was encountered in 5 of 1183 (0.4%) patients undergoing surgery. Once IM was suspected, a standardized approach was applied: rightward shift of ports, confirmation of IM by the absence of the ligament of Treitz, identification of the duodenojejunal junction, lysis of Ladd’s bands, mirror-image construction of the Roux limb and construction of the gastrojejunal anastomosis. Forty percent were male, age 33 ± 8 years, with body mass index 50 kg/m2 (37–75 kg/m2). IM was identified preoperatively in two patients (40%). All operations were completed laparoscopically. Despite the finding of IM, successful laparoscopic completion of gastric bypass can be anticipated if the surgeon has an understanding of the anatomic alterations and a strategy for intraoperative management.

Omental Infarction: A Review of 3 Cases

Omental infarction is an unusual cause of abdominal pain presenting in both adults and children; though it is rare in both [1, 2]. The difficulty is in the initial diagnosis where it can present in a number of different ways and may mask an underlying surgical condition [3, 4]. Most cases are managed without surgery, however; continuing or worsening pain may push a surgical approach. We present 3 cases of omental infarction, all with characteristic radiological findings. One had accompanying radiological features of acute appendicitis, another continued abdominal pain and the third with symptoms responding well to analgesia. The first and second patients required laparoscopic intervention, while the third was managed conservatively.