Lateral abdominal wall hernias refer to structural weaknesses in the muscles and fascia along the side of the abdomen. These defects are relatively rare and can be challenging to diagnose due to their location and often subtle presentation. Patients may experience localized pain or discomfort.
The aim of this presentation is to describe a case of a patient with a lateral Spigelian hernia and to demonstrate a minimally invasive technique for its correction.
Step into the world of advanced surgical procedures with our comprehensive video on Robot-Assisted One Anastomosis Gastric Bypass. This meticulously edited video guides you through each of the 10 standardized steps employed in our high-volume surgical unit, showcasing a state-of-the-art approach to gastric bypass surgery. The steps are:
Treitz Ligament Identification;
Biliary Loop Measurement;
His angle dissection;
Lesser Sac Opening;
Gastric Pouch Creation;
Gastrojejunostomy;
Gastrojejunostomy Fixation;
Methylene Blue Test;
Alimentary Loop Fixation;
Petersen Defect Closure.
This video provides an invaluable resource for surgeons, medical professionals, and enthusiasts interested in the intricacies of Robot-Assisted One Anastomosis Gastric Bypass. Our standardized technique aims to contribute to the advancement of knowledge and skills in the field of bariatric surgery. Embrace innovation and precision in every step of this transformative surgical journey.
Laparoscopic surgery is a technically demanding procedure that requires a significant level of experience and expertise. Since surgery is the mainstay treatment of rectal cancer, comprehending the complexities of multilaminar structures and interfascial spaces is imperative.
This is the case of a 68-year-old woman who was evaluated for a positive fecal occult blood test. Colonoscopy found a vegetative lesion 15 cm from the anal verge, occupying ~1/2 of the lumen. Biopsy and distal tattooing were performed. Pathology study confirmed the presence of a moderately differentiated adenocarcinoma.
The CT-scan showed no lung or liver metastasis. MRI revealed an upper rectal cancer, 11.4 cm from the anal verge, with no pathological lymph nodes, staged as cT2 N0 Mx CRM-.
After discussion in a multidisciplinary meeting, a laparoscopic anterior rectal resection was proposed.
By segmentation of the surgery into well-organized stages, this video demonstrates all the important technical steps to fasten the learning curve and master the procedure without compromising the oncologic principles.
In this video we present the case of a 98 year old chinese gentleman who presented to the emergency department for 2 days of painful right groin lump. He has a history of bilateral inguinal hernia for many years, but declined surgery. Otherwise, his past medical history includes degenerative disc disease, osteoporosis and hearing impairment. On presentation, he was able to tolerate oral feeding with no nausea or vomiting and still able to pass stools. On examination, there was a large and tender right irreducible inguinal hernia with overlying erythema and warmth. There was also a small left inguinal hernia that was reducible. CT Abdomen-Pelvis was done and showed an incarcerated right inguinal hernia containing a loop of sigmoid colon with poor enhancement of the bowel wall. The colon proximal to the incarcerated segment was also mildly dilated.
Patient underwent urgent repair of the strangulated right inguinal hernia via laparoscopic, transabdominal preperitoneal (TAPP) approach. Intra-operatively, a loop of sigmoid colon was incarcerated within a direct right inguinal hernia. A small colotomy had to be made to decompress the incarcerated loop in view of difficulty in reducing the sigmoid colon. After reduction, the incarcerated segment was gangrenous and non-viable requiring sigmoid colectomy with primary anastomosis. Pantaloon inguinal hernias with femoral hernias were seen over bilateral groins. An Ultrapro 10x15cm composite mesh was inserted over bilateral groins with adequate medial overlap ensured.
The operation took three hours and fifty minutes with minimal blood loss. Drain was removed and feeding was escalated to diet on post-operative day four. Patient was able to pass stools and then discharged on post-operative day six. His case was complicated with a small 2cm seroma at the right groin.
A 75-year-old male with history of chronic HCV- related hepatitis, in regular follow-up and sustained viral response (SVR), presented at our Emergency Department for sudden epigastric pain. Urgency CT scan and subsequent abdominal MRI revealed a 2,5cm monofocal HCC in S5 with surrounding hepatic hematoma (7cm of extension) and hemoperitoneum layer. The procedure consisted in laparoscopic exploration, lysis of tenacious adhesions between hepatic hematoma and the right colic flexure, intraoperative ultrasound to assess tumor extension, preparation of Pringle Maneuver and parenchyma transection with ultrasound dissector combined with colecistectomy.
A 47-year-old male, with a history of multiple cholelithiasis and multiple choledochal lithiasis, who presented with multiple episodes of cholangitis for which endoscopic treatment (ERCP + stenting) was performed. After 4 unsuccessful attempts to resolve the bile duct by endoscopic approach, it was decided to perform minimally invasive laparoscopic surgery.
In this video we can observe the Choledochotomy, followed by extraction of stones and biliary mud. Subsequently, a choledochoscopy is performed with the laparoscopic camera (10 mm) with infusion of sterile Physiological Solution since the patient had a very dilated bile duct. Choledochorrhaphy is then performed.
Contributors: Marco P. Fisichella
65 year old man who underwent a laparoscopic Nissen fundoplication in August 2015. Preoperative manometry was normal and DeMeester score was 25. Two months later he began to experience difficulty of swallowing solid foods, then liquids. After 2 dilatations, dysphagia persisted.
DOI#: http://dx.doi.org/10.17797/egw2097cpq
Referred By: Jeffrey B. Matthews
This video depicts the procedure for the implantation of a LINX implant for augmentation of the LES for refractory GERD.
DOI:http://dx.doi.org/10.17797/69av5w723r
Editor Recruited by: Dr. H. Leon Pachter
Contributors: Craig Rezac, MD
Treatment for recurrent or complicated diverticulitis is surgical resection. Minimally invasive techniques are associated with decreased length of stay and decreased post operative pain. However, laparoscopic low anterior resection is challenging especially in the narrow pelvis. Robotic surgery may overcome these obstacles and allow more surgery for divertiuclitis to be performed minimally invasively.
These surgeons always do a LAR for diverticulitis because they transect on the proximal rectum. They take down the lateral stalks in order to mobilize the rectum and get the eea stapler through the rectum easier.
Bilateral ureteral stents are routinely placed to better identify the ureters. This is especially important in cases of chronic/active diverticulitis or diverticulitis that has been complicated by abscess or fistula. This is the preference of the surgeon.
DOI# http://dx.doi.org/10.17797/y1f1omu3mt
Contributors: Reza Salabat and Marco P. Fisichella
Preoperative work-up and surgical technique of laparoscopic paraesophageal hernia repair.
DOI#: http://dx.doi.org/10.17797/c2kvm64ru5
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