Meeting: SAGES 2016

Laparoscopic Gastric Duplication Cyst Excision During Sleeve Gastrectomy

Enteric duplications are rare congenital anomalies with gastric duplication cysts accounting for less than 5% of cases. This is our experience with laparoscopic excision of a gastric duplication cyst located within the gastrohepatic ligament during sleeve gastrectomy. Using intraoperative fluorescence imaging, we were able to verify perfusion to the proximal stomach and liver after cyst excision prior to completion sleeve gastrectomy.

Complicated Chyle Leak after Laparoscopic Median Arcuate Ligament Release Requiring Reoperation with Laparoscopic Suture Ligation

We present a case of a 46 year-old female with a diagnosis of median arcuate ligament syndrome who underwent laparoscopic median arcuate ligament release complicated by a persistent chyle leak requiring reoperation with laparoscopic suture ligation for definitive repair.
Our technique for laparoscopic median arcuate ligament release is demonstrated. The first description of chyle leak complicating laparoscopic median arcuate ligament release is described. Persistent chyle leak necessitating reo

Per-oral Endoscopic Myotomy for Refractory Dysphagia After Heller Myotomy

Heller myotomy is considered the gold standard for Type III achalasia and diffuse esophageal spasm. However, Per-Oral Endoscopic Myotomy (POEM) is a well-documented endoscopic technique for the treatment of achalasia and has been described as a safe and feasible approach for patients after failed surgical myotomy in single institution studies. We are presenting a case of a patient who underwent POEM following Heller myotomy after reporting persistent symptoms of dysphagia and evidence of ongoing

Management of Sleeve Gastrectomy Leaks with Endoluminal Vacuum Therapy

Introduction: Sleeve gastrectomy has become a popular weight loss procedure with great success, but is associated with staple line leak that can result in high morbidity and mortality. Current management options range from endoscopic stent placement to surgical intervention. Endoluminal vacuum (E-Vac) therapy has been recognized as a viable option for use in anastomotic leaks and perforations of the GI tract.
Methods: We present a case of a patient that has had several operations following a la

Laparoscopic Hepatectomy Utilizing Fluorescence Imaging for Identification of Hepatic Tumors and Perfusion

Since 2008, we have applied intraoperative fluorescence imaging using indocyanine green (ICG) to real-time visualization of the bile ducts, hepatic tumors, and hepatic segments during hepatobiliary surgery. With the advent of commercially-available fluorescence imaging system, the ICG-fluorescence imaging techniques have begun to be applied to laparoscopic and robot-assisted surgery widely. Herein, we present a case of laparoscopic hepatectomy for colorectal liver metastases, in which intraopera

Robotic extralevator abdominoperineal excision of the rectum with pelvic floor reconstruction using biologic mesh

Extralevator excision of the rectum has been shown to improve margin negativity in abdominoperineal resection. This can be technically challenging, and the resultant pelvic floor defect can make adequate closure difficult. Here we present a hybrid laparoscopic and robotic extralevator abdominoperineal excision of the rectum with pelvic floor reconstruction using biologic mesh. This approach facilitates pelvic dissection and perineal closure while maintaing acceptable hernia, wound and pelvic com

Robotic-Assisted Excision of Type I Choledochal Cyst with Hepaticoduodenostomy

Case Presentation: A 15-year-old female with morbid obesity who underwent workup for recurrent right upper quadrant abdominal pain. Ultrasonography detected extra-hepatic cystic lesion. Subsequent Magnetic Resonance cholangiopancreatography demonstrated 3.7 x 3.0 cm type I choledochal cyst. She underwent robotic-assisted excision of choledochal cyst with hepaticoduodenostomy.
Technique details:
Extensive adhesions between omentum and the gallbladder were noticed and divided with the hook elec

Revision Roux Limb

Our patient is a 72 year old female who underwent an open roux-y-gastric bypass nine years ago at an outside hospital in a retrocolic, antegastric fashion. She underwent a diagnostic laparoscopy for nausa/vomitting 1 year ago and had an internal hernia repaired with a questionable twist in her intestines. She presented to our institution with worsening abdominal pain, intractable nausea/vomitting with CT scan findings concerning for an internal hernia. Pt was taken to the operating room. It

Laparoscopic complete mesocolic excision with radical lymph node dissection via 3-dimentinaly recognition of gastrocolic trunk for right colon cancer

We performed laparoscopic complete mesocolic excision (CME) via combining medial and cranial approaches with mesofascial separation for right colon cancer. The procedure allowed us radical lymph node dissection via 3-dimentional recognition of gastrocolic trunk.

Intragastric Endoscopically Guided Pancreatic Cyst-Gastrostomy & Necrosectomy

We present a case of a 57 year old patient with a history of ulcerative colitis and alcohol abuse presenting initially with gallstone pancreatitis who developed walled off pancreatic necrosis (WON) three weeks s/p laparoscopic converted to open cholecystectomy. His WON was initially treated with placement of two fully covered, double flanged, lumen opposing, metal stents for internal drainage. A total of 6 sessions of endoscopic debridement were performed, each providing temporary relief; howeve

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