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.
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
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
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
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
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
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
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
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.
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
Giant pulmonary hydatid cyst is a rare entity reported in the preadult age group compared to adults. Definitive surgical management by video assisted thoracoscopic surgery (VATS) is promising and safe. Very few cases of giant complicated hydatid cyst by endoscopic intervention have been reported in the literature and we report a case managed by VATS in a teenager.
This video shows a robotic ileocecal resection in conjunction with a takedown of an enterovesicular fistula. The patient had a three year history of fistulizing Crohn’s disease and suffered from fecaluria and pneumaturia along with recurrent urinary tract infections. The video displays the dissection along with reconstruction using an intracorporeal anastomosis. Robotic techniques are feasible for use in treating inflammatory bowel disease.
We report the case of a 72 y/o male patient who was evaluated for a long-standing history of foul-smelling belching, halitosis and dyspepsia. He was diagnosed with a 8 cm gastric diverticulum. The operation was performed via a laparoscopic approach and the diverticulum was resected with an endoscopic stapler. The patient is symptom-free after the operation.
Gastrogastric fistulas occur in 3-6% of Roux en Y gastric bypass patients. They can cause abdominal pain, asymptomatic weight regain, and marginal ulcer formation. While surgical revision is the mainstay of treatment, we demonstrate a case of successful endoscopic suture closure of a large gastrogastric fistula causing persistent weight regain eight years after banded Roux en Y gastric bypass.
Background: We present a case of transanal endoscopic microsurgery (TEM) in an approach to rectal sleeve resection. A 46 year old man, with a history of immunosuppression, status post pancreas and kidney transplant, presented with a circumferential rectal stricture 7 cm from the anal verge, discovered on flexible sigmoidoscopy for concern of ischemic colitis. He recently had an endovascular repair of an aortic aneurysm (EVAR) with possible occlusion of the inferior mesenteric artery. The rectal
Cystoceles and rectoceles are common findings in women after childbearing and often occur concomitantly. Although abdominal sacrocolpopexy is the gold standard in apical prolapse repair, newer techniques including robotically assisted laparoscopic sacrocolpopexy have made significant strides in reducing patient morbidity as well as length of hospital stay. We present a case of a 45yo multiparous female with grade 2 cystocle and rectocele, who had failed a previous repair using a vaginal approach
Introduction:
Post-operative complications such as anastomotic leaks and staple line dehiscence are associated with significant morbidity and mortality. Previously, endoscopy was used for the diagnosis and treatment of only small leaks and fistulae. Currently, novel therapeutic techniques can treat a wide variety of post-surgical complications. Here, we present a case of a large staple line dehiscence with leak managed by endoscopic suturing.
Case:
A 72-year-old male with a history of reflux
Introduction: Since the introduction of divided Roux -en- Y Gastric Bypass (RYGBP), the incidence of gastro-gastric fistula has been greatly reduced. When a fistula is present, it is usually followed by weight gain, abdominal pain or refractory ulcers. Fistulization between gastric segments is a late complication after (RYGBP). There are many ways to approach the resolution of this complication which depends on the characteristics of the fistula.
Material and Methods: The patient was a 46-ye
Background: The advantages of laparoscopic liver resection become more obvious as evidence on its long term outcome has emerged. Compared to open resection, there is no difference in term of overall survival. During laparoscopic liver resection, surgeons cannot use their tactile sensation to feel the liver and to evaluate the margin from the tumour. ICG immuofluoresence navigation is a new method to provide a visualisation of the tumor on display screen during the operation.
This video will dem
Marginal Ulcers (MU) are the most common cause of bleeding after RYGB. Surgical management is required if endoscopic treatment fails to control the bleeding. In this video, we present the case of a laparoscopic repair of an actively bleeding marginal ulcer after RYGB. The repair was performed via a jejunal enterotomy with meticulous ligation of bleeding vessels, and did not require revision of the gastrojejunal anastomosis.
The Vertical Banded gastroplasty (VBG) was a completely restrictive alternative to the Roux-En-Y gastric bypass (RYGB). It involved a gastric pouch formed from a non-divided staple line with a distal restrictive silastic band. Unfortunately, up to 40-60% of patients that underwent this operation developed chronic dysphagia from an obstructing silastic band placed at the distal end of the gastric pouch. Many of these patients benefit from conversion of their VBG to a RYGB to address both their m
Introduction: Chronic gastric leak after sleeve gastrectomy is one the most insidious complications in bariatric surgery. Multimodal treatment using endoscopic, surgical and interventional radiology approaches is often necessary. A gastric leak progresses rarely into a gastro-colic fistula and usually occurs when initial control of the leak is not achieved. The aim of this video is to show a minimally invasive laparoscopic treatment for a chronic fistula between the gastric antrum and transverse
This is a case of a 65 y/o morbidly obese female with severe acid reflux requiring high dose PPI. We elected to perform SIPS, paraesophageal hernia repair with mesh and Nissen fundoplication on her. She lost 40% of her excess weight with resolution of reflux by 6 months.
Here we present the technique, SIPS with LF that provides substantial weight loss with GERD resolution.
INTRODUCTION: Minimally invasive (MI) esophagectomy presents proven benefits over the open approach. Nevertheless postoperative leaks and chylothorax still remain an important cause of morbidity and mortality. The optimal treatment for esophago-gastric anastomotic leaks is controversial with minimally invasive techniques, especially self-expandable metallic stents (SEMS) gaining popularity. Chylothorax after esophagectomy also remains a challenging clinical problem with a mortality rate reaching