Laparoscopic Ligation of a Type II Endoleak from the Inferior Mesenteric Artery

Contributors: Gregory Westin and Paresh Shah

Endovascular stent grafting (EVAR) is now the preferred approach to repair of abdominal aortic aneurysms for many patients. One of the most common complications associated with EVAR is the development of an endoleak, or continued flow of blood into the aneurysm sac outside the graft. Type II endoleaks, those due to retrograde flow through a branch vessel such as the inferior mesenteric artery (IMA) or a lumbar artery, are the most common. Options for treatment include transarterial embolization, translumbar embolization, and laparoscopic ligation. Embolization techniques require reintervention in approximately 20%, with less than half free from aneurysm sac growth at five years, though current evidence is insufficient to determine a clear threshold for intervention or optimal technique.[1,2]

DOI#: http://dx.doi.org/10.17797/wu4visdfw2

Laparoscopic Extracorporeal Repair of a Morgagni Diaphragmatic Hernia

Contributors: Anahita Jalilvand  and Marco P. Fisichella

This video describes a laparoscopic-extracorporeal repair with mesh of a Morgagni diaphragmatic hernia in an 81 year old female.

We used Ventralight™ ST Mesh which is an uncoated lightweight monofilament polypropylene mesh on the anterior side with an absorbable hydrogel barrier based on Sepra® Technology on the posterior side for laparoscopic ventral hernia repair. The posterior side mesh does not cause adhesion with the abdominal organs.

DOI: https://doi.org/10.17797/k8ktfjncgn

A quick review of the literature of laparoscopic cases has shown that in a substantial amount of cases the hernia was reduced and the defect repaired with mesh placement without hernia sac resection . Therefore, non-resecting the sac is an acceptable option.

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