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PubMed1981

[A new technique for extended left nephrectomy (author's transl)].

Description of a technique for extended left nephrectomy, the originality of which lies in the approach to the pedicle via a supra-mesocolic way. Opening of the posterior cavity of the epiploons, upward displacement of the pancreas and downward displacement of the mesocolon give wide exposure of the vessels and sub-pedicular lymph node dissection is possible under good conditions. The spleen is less exposed than in the classical approach. Only experience will make it possible to fix the limitations and role of this technique which the authors have been using for the past two years.

Humans↗
PubMed1980

[Penetrating abdominal wounds].

37 cases of penetrating abdominal wounds, 10 stab wounds and 27 gunshot wounds, have been examined. They are part of a total of 1856 emergency surgery operations carried out consecutively over a period of 30 months; they therefore represent 2%. The series consisted of 31 men and 6 women; average age was 31. The organs most frequently damaged were the liver, the small intestine and mesentery, the large intestine and mesocolon. Reoperation proved necessary in 7 gunshot wounds, the incidence being much higher than in all other emergency operations carried out. Mortality rate was very high (21.62%): one case of the stab wounds and seven of the gunshot wounds. In spite of the considerable overall seriousness 3 cases, 1 stab and 2 gunshot wounds, did not present visceral lesions. This leads us to agree with numerous authors who maintain that a penetrating abdominal wound is not an absolute indication for surgery but requires, like blunt abdominal injuries, individual surgical evaluation, and in some cases conservative management.

Abdominal Injuries↗
PubMedDate not supplied

[Colon endometriosis: radiological diagnosis (author's transl)].

The radiological signs of the three anatomical types of colon endometriosis are described. The marginal type may occur as a simple isolated fixed lesion with well-defined curved edges and a normal mucosa, the mucosal forms being sometimes stretched in the shape of an arc. In some cases this type is associated with perilesional modifications in the folds, the bands of adhesions showing up as saw-tooth spicules or characteristic newly formed folds in the shape of "roman tiles". The circumferential type shows fixed narrowing without proximal dilatation, conservation of the mucosa, and sometimes a "wheel rim" appearance from retraction of the mesocolon. The third type are the diffuse pelvic forms, when there is a primary colon lesion and signs of pelvic spread have to be investigated by coelioscopy. Diffuse pelvic forms with secondary spread into the colon raise the diagnostic problem of the "extrinsic colon".

Colonic Neoplasms↗
PubMed1995

Trans-scrotal intra-abdominal injuries: two case reports.

Penetrating injury to the scrotum is uncommon. Usually not serious in itself it may be associated with other more serious conditions. A 15-year-old boy was involved in a tobogganing accident, and a shard of wood penetrated the left scrotum, the anterior abdominal wall and the rectus sheath one-third of the way from umbilicus to xiphisternum. There was also a liver laceration. Removal of the piece of wood and closure of the wounds with drainage resulted in successful recovery. A 45-year-old man, sustained a penetrating straddle-type injury from a broom handle. The handle penetrated Dartos fascia but there was no testicular injury. It also perforated the rectus sheath 6 cm inferior to the costal margin, and both anterior and posterior gastric walls. The tract of the handle extended along the base of the transverse mesocolon and posterior to the pancreas. The perforations were debrided and repaired. The patient received a 5-day course of broad-spectrum antibiotics and recovered fully. As a result of their experience with these two patients the authors recommend that when there is penetration of Dartos fascia, the testicle and cord should be inspected, lavage and débridement should be carried out, and any foreign bodies should be removed and the injuries repaired. Antibiotics should be given perioperatively. In all cases the entire tract should be explored to its terminus to search for other injuries. Even upper abdominal injuries can occur with penetrating scrotal injuries.

Abdominal Injuries↗
PubMed1995

[Treatment of acute sigmoid diverticulitis and development].

In acute diverticulitis of the sigmoid colon, the initial therapeutic decision is wether to employ medical or surgical treatment and, thereafter, wether elective resection of the involved bowel is needed. According to the criteria used for the diagnosis of diverticulitis and to the length of the medical follow-up 10 to 25 per cent of patients with diverticulosis will develop some form of peridiverticular inflammation. Adequate treatment of diverticulitis requires antimicrobial therapy directed against both facultative and obligate anaerobic gram-negative bacteria. Computed tomography is now widely regarded as the most informative modality in the diagnosis and the prognosis of extra-colonic extension of diverticulitis. Urgent operation or percutaneous drainage is required for paracolic abscess not confined to the mesocolon. Common indications for delayed operations are residual abscesses, stenosis, fistulae, well defined recurrent diverticulitis and failure to exclude a colonic carcinoma. However, recent prospectives studies have demonstrate that the high frequency of disease recurrence justify to propose prophylactic sigmoidectomy after the first attack of diverticulitis, especially if the patient is younger than 50 years, obese or immuno-compromised.

Acute Disease↗
PubMed1994

Mesenteric panniculitis: report of two cases.

Mesenteric panniculitis is a rare inflammatory process of the mesenteric fat with unknown etiology. We report two pathologically proven cases of mesenteric panniculitis. Both patients presented with abdominal pain and palpable masses. In one patient, computed tomography (CT) demonstrated a well-defined heterogenous mass containing fat density at the mesocolon. In the other patient, CT showed a fatty mass encompassing mesenteric vessels at the root of the mesentery. Although the definite diagnosis of mesenteric panniculitis depends on histopathology, recognition of CT features is helpful in the diagnosis and avoids unnecessary extensive operation.

Adult↗
PubMedDate not supplied

[Indications for laparoscopy in the diagnosis and treatment of abdominal trauma].

The use of laparoscopy as a diagnostic method dates back to the first decades of this century. Laparoscopic surgical techniques were first used by gynecologists and later, in 1989, Dubois performed the first cholecystectomy using a laparoscopic approach. Since then, in the space of a few years, there has been an overwhelming spread of videolaparoscopic operating methods, extending the therapeutic possibilities to gastroenterological surgery, as well as to thoracic, oncological, urological, and of course, gynecological surgery. The use of the laparoscope as a diagnostic method in abdominal trauma was proposed in the 70s by a number of authors, but only now, due to technological progress and the constant use of elective laparoscopic surgery, have surgeons been able to use this method for the diagnosis and treatment of patients with blunt or penetrating abdominal trauma. The experience accumulated to date includes a restricted number of cases, but preliminary results are encouraging and it is expected that this method will also be extended to emergency traumatology. The authors' preliminary experience consists of 7 laparoscopic examinations in subjects with abdominal trauma and hemoperitoneum. In 6 patients the examination confirmed hemoperitoneum caused by splenic lesion in 5 cases and hepatic lesion in 1 case. A hematoma of the left mesocolon was observed in one patient and the authors refrained from other treatment. In one subject with a splenic rupture at the ileum it was necessary to convert the operation into splenectomy. In a further 5 cases repeated washing and aspiration were used, using biological necks when necessary, until bleeding had completely ceased.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Injuries↗
PubMed1994

[Colonic complications associated with acute necrotizing pancreatitis].

Authors found colonic involvement in 9 cases of the 83 patients who have undergone surgical procedure for acute pancreatitis (10.8%). The form of the complications were inoperable extensive necrosis in two, resectable isolated necrosis in four and colo-cutaneous fistula in three cases. Acute extrapancreatic fat necrosis usually caused segmental necrosis of the colon while abscess generally led to fistulization. Complications based rather on ischaemic damage of mesocolon than direct enzymatic influence. Five patients died. Analysing this late, severe involvement, which appeared average on 18-th day, authors try to find relationships between pathomechanism, therapy and mortality rate.

Abscess↗
PubMed1975

[The chronic afferent loop syndrome (author's transl)].

Between 1968 and 1973, 12 patients with a chronic afferent loop syndrome were treated at the University Surgical Hospital in Munich (6 from own hospital and 6 B II resected patients from external hospitals). 11 of them had to undergo reoperation (1 patient refused). X-ray and gastroscopy confirmed the diagnosis of chronic afferent loop syndrome type I in all 12 cases. The obstruction was caused by: adhesion and kinking of the loop (7 cases), too long and mobile loops (6 cases) incorrect anastomosis (3 cases), torsion and stenosis in the mesocolonic slit (2 cases), internal hernia (1 case). 8 patients showed good operative results, in 2 patients symptoms still persist; 1 patient died of sepsis postoperatively.

Adult↗
PubMed1994

[Laparoscopic ileocecal resection in Crohn disease].

Patients with Crohn's ileocolitis may undergo laparoscopic ileocolectomy if an abscess or fistula is not present. At the beginning of the procedure, the mesentery and right mesocolon is dissected from the retroperitoneum without mobilization of the lateral attachments. The ileocolic vessels are identified and clipped. The resection lines are marked, the mesentery is divided with scissors, and the vessels are clipped or coagulated. If the intestine is completely mobilized, a functional end-to-end-anastomosis can be carried out. Ten laparoscopic ileocolectomies were performed since May 1993: Patients' median age 31 years (range 22-39 years), 7 women and 3 men, median operative time 115 min. (range 45-220 min.). Two intraperitoneal anastomoses and three laparoscopic-assisted resections were accomplished. No intra- or postoperative complications were noted. The first postoperative bowel movement occurred in all patients by the fifth postoperative day. The median hospital stay was 5 days (range 4-7 days). An ileocolectomy can be performed as entire laparoscopic or laparoscopic-assisted procedure dependent on intraoperative findings. The morbidity is low and patients appear to recover quickly.

Adult↗
PubMed1994

Laparoscopic adrenalectomy in patients with primary aldosteronism.

Advances in laparoscopic surgery have changed our approach to many surgical problems. We describe a technique of laparoscopic adrenalectomy in patients with primary aldosteronism using an anterior transabdominal approach. The left adrenal gland was approached through the root of the transverse mesocolon, the right adrenal gland through the subhepatic space. The patients were discharged within 24 to 48 h with normal blood pressure after discontinuation of antihypertensive medication. This technique is safe and allows the patient to return to normal activity sooner than with conventional surgery.

Adrenalectomy↗
PubMed1993

[Segmental ischemic colitis in lymphocytic thrombotic venulitis].

This case illustrates the difficulty of diagnosing a colonic stenosis of ischemic origin. A 70-year-old lady presents with abdominal pain, fever and melaena. Lc are 15.2, ESR 39 mm, CEA 2.7 ng/ml. A barium enema shows a stenosis of the transverse colon that is suspicious of neoplasia. At time of operation, an induration of the transverse colon is found with edema of the corresponding mesocolon but no tumour is palpated. A resection of this area is performed and an end to end anastomosis performed. Pathology shows an ischemic colitis secondary to a lymphocytic thrombotic venulitis. The patient is discharged home one month postoperatively. 4 weeks later she is readmitted with the same symptoms. A gastrograffin enema shows a similar stenosis in the transverse colon including the anastomosis. The diagnosis is made of a recurrent ischemic stenosis. The patient improves over a 10-day period of conservative treatment (anticoagulation, TPN, steroids). A control barium enema shows a near resolution of the stenosis. The majority of ischemic colitis are of arterial origin nevertheless ischemic colitis of venous origin exists. The factor causing venous ischemia are not known. It is though thought to be associated with hypersensitivity vasculitis of drug origin. Its initial diagnosis versus neoplasia is difficult but once made there is a good response to a conservative treatment.

Aged↗
PubMed1995

Total laparoscopic proctocolectomy and laparoscopy-assisted proctocolectomy for inflammatory bowel disease: operative technique and preliminary report.

We present the operative technique of laparoscopic proctocolectomy along with the clinical course of the first four patients to undergo this procedure. The operation was conducted through five 12-mm ports. In total laparoscopic proctocolectomy, the dissection began with the sigmoid, left colon, and rectum. The gastrocolic ligament was opened at the level of the midtransverse colon and dissected along with the transverse mesocolon toward the splenic flexure. The attachments and vessels of the right side of the gastrocolic ligament and the right colon were taken last. This sequence was followed because gradual mobilization of the colon displaced all structures in the middle of the abdomen and obscured vision. The specimen was extracted through the anus. In laparoscopy-assisted proctocolectomy, it was necessary to incise only the white line of Toldt of the ascending and descending colon, mobilize the hepatic and splenic flexures, and ligate the vessels of the gastrocolic ligament. Then the vessels of the mesentery were ligated near the bowel wall through a 6.5-cm midline subumbilical incision from which the abdominal colon was also extracted. The rectum was then completely dissected and sectioned at 10-15 cm from the anus, everted, and resected at the dentate line. Mean operative time was 7 h, 18 min, and average blood loss was 493 ml. One patient had urinary retention. Return to liquid diet took a mean of 4 days. Average postoperative stay, which depended on full return of bladder function and teaching of stoma care, was 10 days.

Adult↗
PubMed1996

[Laparoscopic abdomino-perineal rectum excision].

In the department of surgery at the Medical University of Luebeck 10 laparoscopic abdomino-perineal rectum resections were performed within 2 years. Using 3-4 working trocars the intraabdominal dissection of the rectum and sigmoid colon, complete lymphadenectomy with radicular dissection of the inferior mesenteric artery and vein, and dissection of the mesocolon and colon were accomplished. Following a conventional perineal excision the specimen was delivered through the perineal wound. The procedure is finished by establishing a conventional colostomy using the upper left trocar incision. The operation times ranged from 4 to 7.5 hours. The patients--51 to 82 years old--left hospital within 2 weeks after operation. 18 months after operation all patients operated with curative intention were still alive and tumor free except one patient, who died after a heart attack without any recurrent tumor. Two smaller, local stoma complications and one venous bleeding occurred postoperatively. There was no conversion to open surgery caused by intraoperative complications. The abdomino-perineal resection seems to be an ideal indication for laparoscopic surgery, because of its completely intraabdominal preparation, the excellent laparoscopic view into the small pelvis, the oncologic lymphadenectomy and the unproblematic delivery of the specimen.

Aged↗
PubMedDate not supplied

Laparoscopic management of superior mesenteric artery syndrome.

Superior mesenteric artery syndrome (SMAS) is a rare clinical condition that should be considered in patients with long-standing abdominal complaints where endoscopic and conventional roentgenographical findings are often negative. It has been claimed that SMAS is caused by intermittent obstruction of the horizontal portion of the duodenum between the superior mesenteric artery and the spine and the aorta. The main target of this presentation is to present our experience in the laparoscopic management of 4 cases of documented SMAS after failure of medical treatment. The laparoscopic severing of the ligament of Treitz is a feasible and safe technique. It could bring about total relief of symptoms in three out of the four patients. The operative time rapidly decreased with the acquaintance of the field. The visualization (exposure) is quite satisfactory. the technique offers added precision and accuracy to the dissection manoeuvres. Recovery was uneventful and rapid with minimal needs for postoperative analgesia. We recommend the use of mini-endoshear (pediatric). Phases of dissection from the mesocolon and retro-pancreatically are presented. We stress the finding of the drainage of the inferior mesenteric vein into the superior mesenteric vein instead of the splenic vein. This could put the inferior mesenteric vein (looking as a fibrous band) in jeopardy. Also it reduces the area of access to the retropancreatic dissection. We raise the possibility of an etiological role of this anatomical variation to the duodenal compression and call upon the study of such a possibility. The importance to attain the proper retropancreatic space has been shown by the possibility of dissecting between the uncinate process and the rest of the pancreas. The psychological impact of a minimal invasive approach together with symptoms relief was quite rewarding.

Abdominal Pain↗
PubMed1996

[Multicystic peritoneal mesothelioma].

We report on a 31-year-old man with a 29 x 15 x 15 cm large abdominal tumor who came to surgery under suspicion of echinococcus cyst of the liver. Histologically, the neoplasm could identified as multicystic peritoneal mesothelioma (synonyma: benign cystic mesothelioma). Additionally some cysts were located in the greater omentum and mesocolon. In contrast to our case the benign cystic mesotheliomas most commonly occur in young women, localized in the pelvis and abdomen and often complicated by postoperative local recurrence. We performed a resection of the right hemicolon and the omentum. Postoperatively no further therapy was necessary because of the benign appearance of the lesion. Close follow-up is required in these patients due to the disposition for recurrences.

Adult↗
PubMed1997

Gastrectomy with combined resection of other organs for carcinoma of the stomach with invasion to adjacent organs: clinical efficacy in a retrospective study.

BACKGROUND: Carcinoma of the stomach invading one or more adjacent organs raises serious concerns over en bloc dissection because en bloc resection has an associated high risk and such advanced carcinoma is frequently associated with incurable factors. Thus, it is important to understand the efficacy of gastrectomy combined with other organ resection and to refine the indications for en bloc dissection. STUDY DESIGN: Seventy-seven patients with carcinoma of the stomach directly invading adjacent organs or structures were analyzed retrospectively to investigate the efficacy of en bloc resection. Forty-one patients underwent gastrectomy combined with resection of one or more invaded organs (combined resection group), while the other 36 patients underwent gastrectomy with palliative abrasion between the primary tumor and the invasion site (noncombined resection group). RESULTS: The five-year survival rate was 23 percent in the combined resection group and 0 percent in the noncombined resection group (p < .05). The 23 curative cases and 18 noncurative cases in the combined resection group had a survival rate of 41 percent and 0 percent, respectively (p < .05). The survival rate after a single organ resection was 29 percent, and after a multiple organ resection, 0 percent (p < .05). Cases of carcinoma invading either the pancreas or mesocolon had a slightly but not significantly better prognosis. In Borrmann type IV carcinoma there was no difference in survival between the curative and noncurative operation. Cases with P1 dissemination had a better prognosis than those of P2 and P3 dissemination. CONCLUSIONS: The best indication for an en bloc combined organ resection was an invasion limited to only one other organ, not more than N2, no incurable factor, and any type except Borrmann type IV. Additionally, an en bloc combined resection would be worth trying for any type of gastric carcinoma with not more than P1 dissemination and with no other incurable factor.

Carcinoma↗
PubMed1997

[Role of laparoscopy in abdominal traumas: a case report].

The Authors report a case of abdominal traumatism by gunshot wound, presenting with retroperitoneal hematoma and hematoma of the mesocolon, treated in emergency laparoscopy. After a literature review and their case report analysis, they confirm the importance of emergency laparoscopy in hemodynamically stable patients, as well as the diagnostic value of peritoneal lavage, positive for minimal and moderate hemoperitoneum. Laparoscopy allows, as the same time in most cases, the diagnosis and the management of the lesion, while surgery is reserved to the cases of severe hemoperitoneum and perforating injuries. The use of laparoscopy in abdominal blunt injuries, has reduced the number of unnecessary laparotomies with related higher incidence of morbidity. The Authors conclude confirming the importance of this technique for its diagnostic efficacy, lower costs, minimal traumatism, and good aesthetic results as observed in the case report for the modality of the injuries, the young age and the previous sternotomy of the patient.

Abdominal Injuries↗