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A case of symptomatic polycystic liver disease treated by fenestration and segmental liver resection is reported. The intraoperative use of ultrasound to define the plane of liver resection is emphasised. No significant post-operative complication was encountered. The clinical presentation, management and treatment are discussed.
Two cases of frontal interhemispheric cysts have been treated by fenestration of the Lamina Terminalis. Clinical and radiological results were good with a CT follow-up 6 and 7 years after surgery. This procedure avoids the interposition of prosthesis. Actually it could be simplified by the use of endoscopic technics.
The cases reported are about an uncommon congenital malformation. They consist of fenestration of the superior vena cava which presents as a left-to-right shunt with two origins at the venous level. Recognized during operation, one may avoid the complicated procedure of open-heart surgery and closure of the defect may be performed by direct suture on the closed heart. This rare malformation should not be confused with the high septal defects combined with anomalous pulmonary vein drainage (sinus venosus type).
The development of a lymphocele is an uncommon but well-known complication following a kidney transplantation. In case of recurrence after puncture and aspiration, a laparoscopic procedure seems to be the treatment of choice. For the preoperative workup ultrasound is essential; CT scan is to be favored if available. A large fenestration is easy to perform laparoscopically and thus the lymphocele is drained into the abdominal cavity. Because of the immunosuppressive treatment, adhesions hindering a laparoscopic approach are unusual. The conclusion is that surgeons trained in laparoscopic techniques have an important role in these infrequent abdominal problems.
Fenestrated Fontan operation was performed in a 19-year-old male with a diagnosis of right isomerism syndrome. Postoperatively, fungal endocarditis due to Candida Albicans and mediastinitis by Methicilin resistant Staphylococcus Aureus (MRSA) occurred. For Candida endocarditis, combined surgery and medical treatment with amphotericin B was effective. MRSA mediastinitis was successfully treated by continuous closed irrigation with 0.5% povidone-iodine solution. This is the 17th reported case of fungal endocarditis after open heart surgery in Japanese literature.
When an aneurysm arises from a limb of an arterial fenestration at the vertebrobasilar junction or in the proximal third of the basilar artery, its surgical management can be an intriguing problem. We report here a case of such an aneurysm successfully clipped through a right subtemporal transtentorial approach.
The authors report two cases of aneurysms originating at a fenestration of the basilar artery treated by endovascular placement of a balloon inside the aneurysm with preservation of the patent vessel.
A rare case of fenestration of the left middle cerebral artery (MCA) is presented. There is a coexistence with hypoplasia of precommunicans part of the right posterior cerebral artery and its "fetal" branching from internal carotid artery. This form of variation may cause mistakes during interpretation of angiographic investigation.
The development of a postoperative lymphocele after renal transplantation is a well-described complication that occurs with relative frequency. Management options have previously included simple aspiration, percutaneous imaging-guided drainage with catheter placement, and operative marsupialization of the cyst into the peritoneal cavity. Because these collections are often multiloculated, catheter drainage may be of limited value, and the recurrence rate is unacceptably high. The operative approach is the most definitive method and is still considered the treatment of choice. This paper describes a laparoscopic approach to peritoneal fenestration and internal drainage of lymphoceles after renal transplant surgery and recommends that this technique be considered the primary mode of therapy for this complication.
The patient is a boy of five years old with asplenia, dextrocardia, right aortic arch, bilateral superior vena cavae, single atrium, common atrioventricular orifice, double outlet right ventricle and pulmonary stenosis. He underwent operations of right Blalock-Taussig shunt and right superior vena cava ligation when he was eight months old and at the age of three years old, bidirectional Glenn procedure and bivalvation of the common atrioventricular valve (CAVV) as he, then, suffered from severe regurgitation of the CAVV. The regurgitation improved from grade 3 to 1 and his recovery allowed the fenestrated Fontan operation at the age of four years and nine months. Bivalvation is an effective means for the mitigation of regurgitation of CAVV and paves the way for application of Fontan-type operation.
The objective of the study was to determine the efficacy of optic nerve sheath fenestration (ONSF) in eyes with progressive visual or field loss in pseudotumor cerebri in spite of medical therapy with oral Diamox. Visual data on 29 eyes of patients with pseudotumor cerebri who underwent ONSF at Bascom Palmer Eye Institute from 1987 to 1995 were studied retrospectively. These patients had progressive visual loss despite medical therapy. Visual acuity and fields were compared before and after surgery (within 1 and 6 months). During a mean follow-up of 15.7 months (range, 1-50 months), visual acuity improved in four eyes (14%), was unchanged in 22 (76%) eyes, and worsened in three (10%) eyes. Visual fields improved in 10 (48%) eyes, remained unchanged in eight (38%) eyes, and worsened in three (14%) eyes (six were lost in long-term follow-up). There were four repeat surgeries in which vision was lost in one eye. Data from these patients indicate that ONSF improves or protects visual function in patients with pseudotumor cerebri who experience deteriorating visual acuity and fields in spite of medical therapy.
We report the case of a serious complication resulting from laparoscopic fenestration of a hepatic cyst. Seven months after the procedure had been performed, the cyst had recurred and ruptured, leading to massive bleeding. Bleeding control and enucleation of the cyst were carried out successfully by conventional surgery. The patient recovered rapidly after an uneventful postoperative period, and no recurrence of the liver cyst was found 20 months after our intervention. This case emphasizes the importance of a strict follow-up and determination of the outcome for this new application of laparoscopic surgery.
Cysts of the liver may be parasitic or non-parasitic, the non-parasitic cysts being further subdivided into neoplastic, inflammatory, post-traumatic and congenital. Symptomatic congenital solitary cysts represent a good indication for laparoscopic treatment. During the therapeutic procedure, the roof of the cyst is fenestrated or removed such that at least one-third of the circumference of the cyst is removed, which is best done using a harmonic scalpel. In order to prevent a recurrence, it is recommended that a portion of the greater omentum be placed in the floor of the cyst, thus filling the cystic cavity.
Bilateral fenestration of the labial gingival tissue of the permanent mandibular central incisors is described. The situation was followed over a 2-year period with no treatment other than prophylaxis and oral hygiene instruction. The final outcome was an apical positioning of the gingival margin, which was lower than that of the adjacent uninvolved teeth.
We report a case of air/thromboembolism of the left anterior descending coronary artery complicating a fenestrated Fontan procedure treated with aprotinin. The patient was successfully treated by saphenous vein grafting to the left anterior descending coronary artery and reconversion of the Fontan circulation to the original cavo-pulmonary connection.
We describe a 42-year-old man with complete duplication or extreme fenestration of the basilar artery. We review the developmental anatomy and embryology and discuss the possible clinical implications and associated findings of this anomaly.
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