Laparoscopic Gastrectomy and Transvaginal Specimen Extraction in a Morbidly Obese Patient with Gastric Cancer

Laparoscopic gastrectomy for cancer has some significant postoperative benefits over open surgery with similar oncologic outcomes. This procedure is more popular in the Far East countries where obesity is not a serious public health problem. In the Western countries, laparoscopic gastrectomy for cancer is not a common procedure, yet obesity is more common. Herein, we aimed to demonstrate the feasibility of laparoscopic gastrectomy for advanced gastric cancer in a morbidly obese patient. Additionally, we used natural orifice specimen extraction as an option to decrease wound-related complications, which are more prevalent in morbidly obese patients. In this case, we performed a fully laparoscopic subtotal gastrectomy with lymph node dissection and Roux-en-Y gastrojejunostomy with the specimen extracted through the vagina. To the best of our knowledge, this was the first report of a natural orifice surgery in a morbidly obese patient with gastric cancer.

Hydatid liver cyst causing portal vein thrombosis and cavernous transformation: a case report and literature review

A 33-year-old male with abdominal distention after meals was admitted to the hospital. He had a history of surgery forhydatid liver cyst. The cyst was located at the liver hilum and there were portal venous thrombosis and cavernoustransformation. It had been treated with partial cystectomy, omentoplasty and albendazole. Two years later at theadmission to our center, his laboratory tests were in normal ranges. Abdominal imaging methods revealed splenomegaly,portal vein thrombosis, cavernous transformation and the previously operated hydatid liver cyst. Upper gastrointestinalendoscopy demonstrated esophageal and gastric fundal varices. Due to his young age and low risk for surgery, thepatient was planned for surgical treatment of both pathologies at the same time. At laparotomy, hydatid liver cyst wasobliterated with omentum and there was no sign of active viable hydatid disease. A meso-caval shunt with an 8 mm indiametergraft was created. In the postoperative period, his symptoms and endoscopic varices were regressed. Therewere four similar cases reported in the literature. This one was the youngest and the only one treated by a surgical shunt.Hydatid liver cysts that located around the hilum can lead to portal vein thrombosis and cavernous thrombosis.Treatment should consist of both hydatid liver cyst and portal hypertension. To the best of our knowledge, this was thefirst case of surgically treated portal vein thrombosis that was originated from a hydatid liver cyst

Hydatid liver cyst causing portal vein thrombosis and cavernous transformation: a case report and literature review

A 33-year-old male with abdominal distention after meals was admitted to the hospital. He had a history of surgery forhydatid liver cyst. The cyst was located at the liver hilum and there were portal venous thrombosis and cavernoustransformation. It had been treated with partial cystectomy, omentoplasty and albendazole. Two years later at theadmission to our center, his laboratory tests were in normal ranges. Abdominal imaging methods revealed splenomegaly,portal vein thrombosis, cavernous transformation and the previously operated hydatid liver cyst. Upper gastrointestinalendoscopy demonstrated esophageal and gastric fundal varices. Due to his young age and low risk for surgery, thepatient was planned for surgical treatment of both pathologies at the same time. At laparotomy, hydatid liver cyst wasobliterated with omentum and there was no sign of active viable hydatid disease. A meso-caval shunt with an 8 mm indiametergraft was created. In the postoperative period, his symptoms and endoscopic varices were regressed. Therewere four similar cases reported in the literature. This one was the youngest and the only one treated by a surgical shunt.Hydatid liver cysts that located around the hilum can lead to portal vein thrombosis and cavernous thrombosis.Treatment should consist of both hydatid liver cyst and portal hypertension. To the best of our knowledge, this was thefirst case of surgically treated portal vein thrombosis that was originated from a hydatid liver cyst

Isolated pneumomediastinum following laparoscopic cholecystectomy: an unpredictable situation

Pneumomediastinum is a clinical event characterized by the presence of air in the mediastinum. Often a result of physical trauma, this condition results from air escaping from the respiratory airway and moving into the mediastinal cavity. Although rare, it can also develop following abdominal laparoscopic surgical procedures. Diagnosis is commonly made by visualizing a radiolucent airline in the mediastinum and/or surrounding the heart following a chest X-ray radiography or a thoracic CT scan. This case study describes the diagnosis, treatment and follow-up of a 51 years old female patient who developed pneumomediastinum following a laparoscopic cholecystectomy

Surgical management of liver traumas in a liver transplantion center analysis of 2 years experience

Despite advances in diagnostic techniques, liver trauma management remains a challenging issue. To audit the 2 years resutls of liver traumas treated surgically. Retrospective analysis of patients who underwent surgery for liver injury were reviewed. Age, gender, type of trauma, haemodynamic parameters, preoperateive hemoglobin, number of injuries to the liver, coexisting organ injuries, type of surgery, duration of hospitalisation, health status on discharge were evaluated. A total of 30 patients underwent surgery for liver trauma, their median age was 35 +/- 17.14 [23 male, 7 female]. Blunt liver trauma was seen in 50% of the cases [n=15], while, remaining had penetrating trauma. Nine patients [30%] were haemodynamically unstable. Number of injuries to the liver were 1 in 13 patients [43.3%] 2 in 7 patients [23.33%] 3 in 4 patients [13.33%] and more than 3 in 6 patients [20%] Twenty two patients [73.3%] had co-existing injuries to other organs too. Among the surgical procedures used, 9 were damage controlling procedures and 9 were definitive repair, and one patient underwent living donor liver transplantion. Mortality was 10% [n=3]. Coexisting organ injuries and hemodynamically unstable status contributed to mortality

Preoperative progressive pneumoperitoneum for giant inguinal hernias

Reduction of giant hernia contents into the abdominal cavity may cause intraoperative and postoperative problems such as abdominal compartment syndrome. Preoperative progressive pneumoperitoneum expands the abdominal cavity, increases the patient's tolerability to operation, and can diminish intraoperative and postoperative complications. Preoperative progressive pneumoperitoneum is recommended for giant ventral hernias, but rarely for giant inguinal hernias. We present two giant inguinal hernia patients who were prepared for hernia repair with preoperative progressive pneumoperitoneum and then treated successfully by graft hernioplasty. We observed that abdominal expansion correlated with the inflated volume and pressure during the first four days of pneumperitoneum. Although insufflated gas volume can be different among patients, we observed that the duration of insufflation may be the same for similar patients

Screening of gastric cancer in liver transplantation patients: a case report and review of literature

Liver and other solid organ transplant recipients are at an increased risk of developing several malignancies because of the immuno-suppressive treatment. Generally, patients who had a liver transplant have upper gastrointestinal tract complaints, which makes identification of gastric carcinoma symptoms in those patients difficult. A 58 years old liver transplant male patient presented to the hospital for his routine checkup and dyspeptic complaints. He had received a liver from a cadaver 18 months ago and his postoperative period had been uneventful. An esophagogastroduodenoscopy [EGD] revealed gastric cancer. A subtotal gastric resection with a D2 lymph node dissection was carried out. There was no recurrence during three years follow up. In order to make a timely identification of the occurrence of common malignancies such as gastric cancer, liver transplant recipients must be followed closely

Investigation of a one-time phenol application for pilonidal disease

To investigate wound healing rates and postoperative recovery of patients after a one-time phenol application for pilonidal disease. A total 30 consecutive patients with chronic pilonidal disease ranging from midline to complex sinuses were enrolled in the study. No preoperative laboratory examinations or bowel preparation were required. No antibiotic prophylaxis or sedation was used. A small incision was made on the midline and hair/ debris in the sinuses was removed. A cotton swab with saturated phenol was moved into the cavity and the phenol was left for 2 min. No special dressing was necessary and patients left the hospital immediately afterwards. Patients filled out a daily questionnaire for 7 days. We did not intervene in the wounds with a second phenol application or curettage during the observation period. Wounds were inspected at weekly intervals for 2 months. At the end of the third day, 97% of the patients were pain-free and 100% of the patients were free from analgesics. Time off work was 2 days for most patients [93.3%]. Twenty-eight [93.3%] patients were satisfied with the procedure, they found it easy and painless and suggested the procedure to other patients. Twenty-five [83%] patients were asymptomatic at the end of 2 months' observation and the remaining 5 patients had un-healed sinuses. Mean time for wound healing was 25 days [range 10-63 days]. There were 4 recurrences after a mean of 14 months' follow-up and the overall success rate was 70%. A one-time phenol application was an effective treatment for pilonidal disease with acceptable wound healing rates, less postoperative pain and less time off work. Hence it can be an alternative treatment modality

Development of two cancers in the same patient after ileorectal and ileal pouch anal anastomosis for familial adenomatous polyposis

To report a case of a patient with familial adenomatous polyposis. A 36-year-old male patient who suffered from rectal bleeding was treated with colectomy and ileorectal anastomosis for familial adenomatous polyposis [FAR] in 1974. After 19 years, in situ adenocarcinoma was detected in the rectal stump. Completion proctectomy, mucosectomy, and hand-sewn ileal pouch anal anastomosis with protective ileostomy were performed. In 2002, a metachronous cancer was detected at the anastomosis and abdominoperineal resection of the pouch and end ileostomy were performed. Later on, the perineum was excised locally because of cancer recurrence. This case shows that lifetime surveillance of the FAR patients after surgery is crucial