Extra-peritoneal Laparoscopic Resection of Benign Prostate Adenoma >150 CC with preservation of posterior wall of prostatic urethra: Dundee Technique and early outcomes

Background There are limited options for men with large benign prostates (>150cc) and bladder outflow obstruction due to benign prostatic hyperplasia (BPH). Management options include surgery (open or minimal access) and endoscopic procedures. There is a paucity of literature on outcomes for prostates >150cc. Methods In this case series we describe a step-by-step, illustrated, modified extra-peritoneal technique of laparoscopic prostatectomy with preservation of the posterior prostatic urethra. This involves creation of extra-peritoneal space, transverse incision of prostate capsule, progressive adenoma dissection, resection, and closure of the capsule. Results Ten patients underwent this procedure between 2015 and 2019. The mean age was 72.4 years and mean prostate size was 215.5cc. Mean procedure duration was 200 min and there were no intraoperative complications. Most patients were discharged on postoperative day 1. Mean intraoperative blood loss was 120 ml with no patient requiring blood transfusion. At follow up (mean 37 months) no patients had residual symptoms of BPH. Conclusion We describe a novel extraperitoneal laparoscopic technique for benign prostates of >150cc with very good outcomes. The transferability of this technique to centres with laparoscopic expertise at minimal extra cost and future adaptability in the robotic setting are some of the advantages of this technique.

Preface of the Special Issue: “Peritoneal Surface Malignancies (PSM): The SICO (Italian Society of Surgical Oncology) PSM—Oncoteam Experience, Result Analysis, and Studies’ Purpose”

Over the past 40 years, strategies to treat neoplastic spread into the peritoneal space have benefitted from a gradually evolving approach, thanks mainly to studies conducted by the charismatic leader in this medical field Professor Paul Sugarbaker, Washington DC[...]

Preoperative Chemoradiotherapy for Gastroesophageal Junction Adenocarcinoma Modified by PET/CT: Results of Virtual Planning Study

Background and Objectives: The treatment of gastroesophageal junction (GEJ) adenocarcinoma consists of either perioperative chemotherapy or preoperative chemoradiotherapy. Radiotherapy (RT) in the neoadjuvant setting is associated with a higher probability of resections with negative margins (R0) and better tumor regression rate, which might be enhanced by incrementing RT dose with potential impact on treatment results. This virtual planning study demonstrates the feasibility of increasing the dose to GEJ tumor and involved nodes using PET/CT imaging. Materials and Methods: 16 patients from the chemoradiotherapy arm of the phase II GastroPET study were treated by a prescribed dose of 45.0 Gray (Gy) in 25 fractions. PET/CT was performed before treatment. The prescribed dose was virtually boosted on PET/CT-positive areas to 54.0 Gy by 9 Gy in 5 fractions. Dose-volume histograms (DVH) were compared, and normal tissue complication (NTCP) modeling was performed for both dose schedules. Results: DVHs were exceeded in mean heart dose in one case for 45.0 Gy and two cases for 54.0 Gy, peritoneal space volume criterion V45Gy < 195 ccm in three cases for 54.0 Gy and V15Gy < 825 ccm in one case for both dose schedules. The left lung volume of 25 Gy isodose exceeded 10% in most cases for both schedules. The NTCP values for the heart, spine, liver, kidneys and intestines were zero for both schemes. An increase in NTCP value was for lungs (median 3.15% vs. 4.05% for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy, respectively, p = 0.013) and peritoneal space (median values for 25 × 1.8 Gy and 25 + 5 × 1.8 Gy were 3.3% and 14.25%, respectively, p < 0.001). Conclusion: Boosting PET/CT-positive areas in RT of GEJ tumors is feasible, but prospective trials are needed.

Physical activity and exercise in peritoneal dialysis: International Society for Peritoneal Dialysis and the Global Renal Exercise Network practice recommendations

Life participation requiring physical activity and physical function is a key patient-reported outcome for people receiving peritoneal dialysis (PD). Clinician guidance is required from multidisciplinary sources regarding exercise and activity advice to address the specific needs of this group. From August 2020 through to June 2021, the Global Renal Exercise Network and the International Society for Peritoneal Dialysis reviewed the published literature and international clinical experience to develop a set of clinical practice points. A set of questions relevant to physical activity and exercise were developed from the perspective of a person receiving PD and were the basis for the practice point development. The GRADE framework was used to evaluate the quality of evidence and to guide clinical practice points. The review of the literature found sparse quality evidence, and thus the clinical practice points are generally based on the expert consensus of people receiving PD, PD exercise expert clinicians and experienced PD exercise researchers. Clinical practice points address timing of exercise and activity (post-catheter insertion, peritoneal space empty or full), the uptake of specific activities (work, sex, swimming, core exercise), potential adverse outcomes related to activity and exercise (exit site care, perspiration, cardiovascular compromise, fatigue, intra-abdominal pressure), the effect of exercise and activity on conditions of interest (mental health, obesity, frailty, low fitness) and exercise nutrition.

The technology of artificial pneumoperitoneum CT and its application in diagnosis of abdominal adhesion

To retrospectively analyze the use of artificial pneumoperitoneum in CT scans, to explore its operation methods and technical points, and to lay the foundation for the widespread application of artificial pneumoperitoneum in CT. A total of 331 patients who underwent artificial pneumoperitoneum with CT angiography from January 1, 2013, to November 1, 2019, were recruited. All patients underwent standardized artificial pneumoperitoneum in the horizontal, left and right lateral, and prone positions during CT thin-layer scans of the abdomen and 3D reconstruction. Taking the surgical results as the gold standard, and using kappa test to verify the consistency of surgical results and imaging results. In all 331 patients, 43 patients had a normal peritoneal space, and 288 patients had an abnormal peritoneal space. And only 22 patients developed complications of subcutaneous emphysema, accounting for 6.6% of all 331 patients. In terms of the postoperative results, 28 were normal, and 303 were abnormal. The sensitivity, specificity and accuracy of CT diagnosis of abdominal adhesions using artificial pneumoperitoneum were 100%, 95.04%, and 95.46%, respectively. According to the Kappa consistency test, the imaging diagnosis from the CT scan with artificial pneumoperitoneum had a high consistency with the surgical results (kappa = 0.796, P < 0.05). The technique of artificial pneumoperitoneum CT is safe, reliable, highly practical, and proficient for obtaining good imaging results. It provides a good imaging basis for the diagnosis of intra-abdominal diseases, especially intra-abdominal adhesions.

Vedolizumab combined with surgical resection successfully treated perforating Crohn’s disease with peritoneal space to rectal and vaginal fistulas: a case report

Background Intestinal perforations and fistulas are common complications of Crohn’s disease. However, chronic perforation with peritoneal space to rectal and vaginal fistulas have not been previously reported. Case presentation A 38-year-old female suffered from progressive lower abdominal pain, diarrhea and weight loss. Terminal ileal chronic perforation with intra-abdominal abscess, peritoneal space to rectal and vaginal fistulas were noted. The patient received surgical resection of the cecum and terminal ileum, and then vedolizumab treatment. Three months later, she had complete fistula closure, and her body mass index had increased from 13 to 22. Conclusion Vedolizumab combined with stool diversion is effective at treating Crohn’s disease with chronic perforation and complex peritoneal space to rectal and vaginal fistulas.

A Giant Pre-Peritoneal Lipoma: A Report of an Uncommon Presentation of a Rare Entity and a Review of the Literature

Background: A lipoma is one of the commonest benign tumors in surgical practice. Lipomas are usually found on the trunk and limbs but less commonly within the abdomen, where they occur frequently in the mesentery as well as the subserosa and submucous layer of the gastrointestinal tract. Pre-peritoneal lipomas are rare. Case Presentation: A 44-year-old woman presented with a painless and progressive right-sided abdominal swelling of 5 months duration. Examination revealed a 16cm x 14cm slightly mobile and non-tender firm-to-hard hour-glass-shaped mass extending from the right hypochondrial to right iliac and the suprapubic regions. Abdominal ultrasonography showed a 5cm x 6cm bowel thickening in the right iliac fossa suggestive of an ileocecal mass while a computerized tomography showed a 20.8cm x 6.3cm x 20.1cm hypodense mass within the peritoneal cavity, extending from the epigastric region to the pelvis, anterior to the bowel loops and more to the right. At laparotomy, a huge, well encapsulated yellowish mass in the pre-peritoneal space, weighing 1,520g was excised. Histology confirmed a lipoma. Conclusion: A preperitoneal lipoma is an uncommon soft tissue tumor and the giant ones are extremely rare. Although a rare cause of a painless abdominal swelling, pre-peritoneal lipoma should be considered as a differential diagnosis in patients presenting with an unremarkable feature suggestive of an intra-abdominal pathology.

Retroperitoneal Primary Cystic Tumours: (Case Series of Seven Patients and Literature Review)

Primary retroperitoneal cystic tumors include all cystic tumors that arise in the retro and sub peritoneal space independent of the kidney, the excretory tract, the adrenal gland, large vessels and contiguous viscera. We propose a retrospective study of 7 cases of primary retroperitoneal cystic tumors, collected in the department of digestive cancer surgery and liver transplantation at the Ibn Rochd University Hospital in Casablanca over a period of 10 years (2009 to 2019). Our patients are divided into 6 women and 1 man with an average age of 42 years. The diagnostic time varies from 3 months to 3 years with an average of 10 months. The revealing signs are mainly pain (7 cases or 100%) and abdominal mass (3 cases or 43%). The positive diagnosis is based on ultrasound (2 cases or 40%) but above all on computed tomography (7 cases or 100%) which specifies the retroperitoneal site as well as the relationship of the tumor to neighboring organs. Its confirmation can only be histological. Surgery with total resection is the treatment of choice.

Acute chylous peritonitis due to idiopathic pancreatitis mimicking acute appendicitis

The acute development and the accumulation of chyle into the peritoneal space is a rare condition and one needs to be able to distinguish it from chylous ascites, which is most commonly chronic and associated with related diseases. It is frequently idiopathic and additionally, clinical and imaging findings are nonspecific. In almost all cases, the diagnosis is made intraoperatively during laparoscopy or laparotomy, most diagnostic procedures being indicated by acute complaints pertaining to the abdomen. A 23-year-old man was admitted to the Emergency Department with abdominal pain, with right iliac fossa tenderness and peritonism. Laparoscopy was performed due to acute abdomen findings. Further exploration revealed chylous effusion with milky-like fluid. The peritoneal lavage and the insertion of drains were subsequent to the careful inspection of the cavity. The biochemical analysis of the peritoneal fluid was an important aid which provided the diagnosis of chylous peritonitis due to acute pancreatitis.

Transmigration of copper T presenting as abdominal wall mass: a case report

Copper T is one of the widely used intra uterine contraceptive devices due to its safe, effective and reversible nature. It has also been widely used as it is cost effective too. Copper T is usually inserted immediate post-partum, post abortal, during the proliferative phase of any menstrual cycle or 6 to 8 weeks following post-partum. Complications associated with use of Copper T include heavy menstrual bleeding, pelvic inflammatory disease, uterine perforation, displacement and rarely, transmigration. Post-insertion of copper T, women need to have regular follow up visits to prevent such complications. Patients should be advised to check for the presence of threads periodically. Considerable number of patients with transmigration of copper T has been reported in literature. Sites into which transmigration has been reported include broad ligament, ovarian fossa, urinary bladder, sigmoid colon, rectum, peritoneum, omentum, pouch of douglas, retro peritoneal space, iliac veins, ovaries, appendix and rarely in the abdominal wall. Transmigrated copper T may be diagnosed with ultrasonogram, X-ray and CT scan. Copper containing intra-uterine devices are known to provoke inflammatory reactions and symptoms depending upon the sites to which they have been transmigrated. Hence, we should resort to early intervention and remove the misplaced copper IUCD at the earliest. Here, we are reporting a rare case of transmigration of copper T into the anterior abdominal wall elaborating on various facets of copper T including its advent, incidence of use, efficient diagnosis and well-planned retrieval.