ABSTRACT
PURPOSE: Anastomotic leakage is a fearsome complication in rectal surgery. Surgeons perform the classic air leak test, although its real effectiveness is still debated. The aim of this study was to describe a personal technique of reverse air leak test in which low colorectal anastomosis was assessed transanally through the intrarectal irrigation of a few mL of saline solution. METHODS: From October 2014 to November 2019, 11 patients with low rectal cancer (type 1 in Roullier classification) were included in this study. At the beginning of the procedure, a circular anal dilator was inserted into the anus. A side-to-end colorectal anastomosis was performed. A few mL of saline solution were injected into the rectum and the entire anastomotic line was directly explored. The appearance of bubbles was considered as an anastomotic defect and repaired with an interrupted suture. A fluorescence angiography after intravenous injection of indocyanine green was performed in order to evaluate the perfusion of the anastomosis. RESULTS: The reverse air leak test was positive in 4 cases (36.4%). The defect was repaired and a confirmation test was performed. In all patients, near-infrared evaluation showed no perfusion defect (grade 0) in low colorectal anastomosis. No postoperative fistula was detected in cohort study. A protective stoma was performed in 10 patients. On day 90, there were no complications and stoma closure was performed as planned. CONCLUSION: The reverse air leak test is a simple, feasible, and effective procedure to identify anastomotic leaks in low colorectal anastomoses.
ABSTRACT
The nephron-sparing techniques allow the excision of kidney tumors preserving renal function and ensuring adequate oncological results. We describe a case of a 77-year-old patient who underwent an ex vivo partial nephrectomy with orthotopic autotransplantation for kidney cancer. The postoperative course was marked by bleeding which required radiological embolization. Postoperative dialysis was required for about 1 month. The anatomopathological examination showed a clear cell carcinoma staged pT1b, pNX, R0. At 2 years follow-up, no recurrence was detected with a complete renal function restoration. Our experience shows that ex vivo nephron-sparing surgery with autotransplantation is a good alternative to total nephrectomy in the case of voluminous or perihilar tumors. Considering the high morbidity of this procedure, it should be only performed in specialized centers.
ABSTRACT
Arterial leiomyosarcoma (A-LMS) is a very rare tumour and no cases originating from the superior mesenteric artery (SMA) have been described. We present a case of A-LMS originating from distal part of SMA and incorporating superior mesenteric vein (SMV). SMA and SMV were prepared along their course by laparotomy. Prior to resection, the superior mesenteric vessels were clamped, and intra-operative infrared angiography after intravenous injection of indocyanine green was performed. Once confirmed the vitality of the bowel, mass resection including the distal portion of the SMA and SMV was executed. The postoperative course was uneventful. Histology confirmed initial diagnosis. Six months after surgery no recurrence was highlighted. This is the first case of A-LMS originating from SMA, successfully treated without any intestinal resection or vascular reconstruction. The use of near-infrared angiography associated with a preoperative angiographic workup is indispensable for the success of the surgery.
ABSTRACT
INTRODUCTION: Merkel cell carcinomas (MCC) is an aggressive neuroendocrine carcinoma originating from the Merkel cell in the dermo-epidermal junction. Only 10% of MCC occur on the skin of the trunk. CASE REPORT: We report a case of Merkel's abdominal carcinomas treated with extensive inguinal lymphadenectomy and reconstruction of the abdominal wall and inguinal canal using prosthesis GORE® BIO-A®. DISCUSSION: Immunohistochemical analysis by tumor-specific markers is crucial for diagnosis and permits differentiation from other tumors of the skin. MCC is an aggressive tumor with poor prognosis. CONCLUSIONS: For primary tumors without indications of the presence of organ metastases complete surgical excision is the gold standard. Gore BIO-A is a biosynthetic prosthesis with manageable structure that allows it to be positioned and shaped according to needs, its strength provides for excellent support for the reconstruction of the inguinal canal wall.
