Abdominoplasty versus endoscopic approach to diastasis recti repair: A comparative study of outcomes.

Diastasis recti (DR) is characterized by the deviation of the abdominal rectus muscle due to widening of the linea alba and laxity of the abdominal wall musculature.1,2 This condition affects the quality of life, in terms of performance of activities of daily living and physical tasks.3-7 Several techniques have been described to correct DR.11 This prospective research aimed at comparing the traditional approaches vs endoscopic plication for DR repair in terms of safety, effectiveness and satisfaction of the patients based on patient-reported outcome measures via the BODY-Q abdomen scale. Materials and Methods: We performed a retrospective multicenter study in 2 departments of aesthetic and plastic surgery, Department of Plastic Surgery, San Carlo of Nancy Hospital, Rome (group I) and Hospital Británico de Buenos Aires, Argentina group II). A total of 85 consecutive patients treated using abdominoplasty access (group I) and 85 consecutive patients treated using an endoscopic approach (group II) were enrolled in the study. The minimum follow-up was 12 months. Results: Descriptive statistics were used to report the counts and frequencies for categorical data. Continuous normally and non-normally distributed data were described as means with standard deviations and medians with interquartile ranges as appropriate. All analyses were performed using the STATA/IC 16.0 software. Conclusion: Our multicenter experience reveals that open and minimally invasive approaches are viable options. Identifying the optimal approach for DR repair should also rely on the patient's desired treatment outcome.

Abordaje laparoscópico de la neoplasia mucinosa apendicular de bajo grado / Laparoscopic approach of low-grade appendiceal mucinous neoplasm

RESUMEN Las neoplasias mucinosas apendiculares son infrecuentes y se clasifican en neoplasias mucinosas de bajo grado, de alto grado y adenocarcinoma mucinoso. Se consideran precursoras del pseudomixoma peritoneal, caracterizado por la acumulación de mucina dentro de la cavidad abdominal. Informamos tres casos de neoplasia mucinosa apendicular de bajo grado, dos varones y una mujer, que presentaron dolor abdominal agudo, diagnosticados preoperatoriamente mediante tomografía y que fueron manejados con un abordaje laparoscópico (apendicectomía, resección parcial de ciego y colectomía derecha, respectivamente). Los tres casos tuvieron una buena evolución posoperatoria y no hubo complicaciones. Se concluye que las neoplasias mucinosas apendiculares son raras y no tienen una presentación clínica específica. El abordaje laparoscópico es una opción segura y factible. La frecuencia y la duración del seguimiento de estos pacientes es motivo de controversia.

ABSTRACT Appendiceal mucinous neoplasms are rare and are classified in low-grade mucinous neoplasm, high-grade mucinous neoplasm and mucinous adenocarcinoma. They are considered precursors of pseudomyxoma peritonei, characterized by the accumulation of mucin within the abdominal cavity. We report three cases of low-grade appendiceal mucinous neoplasm, two men and one woman, who presented with acute abdominal pain. The diagnoses were made preoperatively by computed tomography scan and the tumors were managed through laparoscopic approach (appendectomy, partial resection of the cecum and right colectomy, respectively). The three patients evolved with favorable postoperative outcome without complications. Appendiceal mucinous neoplasms are rare without specific clinical presentation. The laparoscopic approach is a safe and feasible option. The frequency and duration of surveillance in these patients are still controversial.

Multiple Jejunal diverticulosis complicated by perforation: case report and a brief literature review

Background: Multiple small-bowel diverticulosis comprises a rare entity with probable underestimated incidence, and that may be the reason why it is sometimes overlooked when managing cases with peritonitis. Case report: In the present paper, we report the case of a 76-year-old male presenting abdominal pain and fever in an acute setting. Computed tomography (CT) scans revealed jejunal thickening and numerous images of saccular addition that were interpreted as jejunoileal diverticulitis. After an initial period of clinical treatment, surgical management was indicated based on a worsening clinical picture and the presence of an extraluminal focus of gas detected in a subsequent CT scan. Through a laparoscopic approach, multiple small-bowel diverticula and a tamponade perforation were found. A segmental intestinal resection was performed, and the patient was discharged after a ten days. Conclusions: Multiple jejunal diverticulosis is a rare condition that should be remembered in the setting of an acute abdomen. As it prevails among older patients, early diagnosis with radiological aid is crucial to establish the most adequate management, including intestinal resection, if necessary. (AU)

Role of laparoscopy in the treatment of internal biliary fistulas in a high-volume center and a review of the literature.

BACKGROUND: Biliary fistulas may result as a complication of gallstone disease. According to their tract, abdominal internal biliary fistulas may be classified into cholecystobiliary and bilioenteric fistulas. Surgical treatment is challenging and requires highly trained surgeons with high preoperative suspicion. Conventional surgery is still of choice by most of the authors. However, laparoscopy is emerging as a minimally invasive alternative. We investigated the surgical approach, conversion rate, and outcomes according to the type of biliary fistula. METHODS: We retrospectively reviewed 11,130 laparoscopic cholecystectomies, 31 open cholecystectomies, and 31 surgeries for gallstone ileus at our institution from May 2007 to May 2020. We diagnosed internal biliary fistula in 73 patients and divided them into two groups according to their fistulous tract: cholecystobiliary fistula and bilioenteric fistula. We described demographic characteristics, preoperative imaging modalities, surgical approach, conversion rates, surgical procedures, and outcomes. We additionally revised the literature and compared our results with 13 studies from the past 10 years. RESULTS: There were 22 and 51 patients in the cholecystobiliary and bilioenteric groups, respectively. Our preoperative suspicion of a fistula was 80%. We started 88% of procedures by laparoscopic approach. The effectiveness of laparoscopy in the resolution of internal biliary fistula was 40% for cholecystobiliary fistula and 55% for bilioenteric fistulas. The most frequent cause for conversion to laparotomy was the difficulty to identify anatomical features, in addition to the need to perform a Roux en-Y hepaticojejunostomy. Choledocholithiasis was not associated with an increase in conversion rates. CONCLUSIONS: Laparoscopic resolution of a biliary fistula is still a matter of controversy. Despite the high conversion rates, we believe that a great number of patients benefit from this minimally invasive technique. A high preoperative suspicion and trained surgeons are vital in the treatment of internal biliary fistulas.

Exploración de las vías biliares como tratamiento de la litiasis coledociana: manejo laparoscópico vs. convencional. Estudio prospectivo y comparativo / Common bile duct exploration as treatment of choledocal lithiasis: laparoscopic vs conventional approach. Prospective and comparative study

La litiasis coledociana es una complicación poco frecuente asociada a la litiasis vesicular. Puede ser resuelta mediante colangiopancreatografía retrógrada endoscópica (CPRE) o en su defecto, una exploración de las vías biliares por abordaje convencional (cirugía abierta) o laparoscópico. Objetivos: Determinar la efectividad del abordaje laparoscópico versus el convencional en la exploración de las vías biliares como tratamiento de la litiasis coledociana. Métodos : Se realizó un estudio prospectivo y comparativo con una muestra de 31 pacientes con litiasis coledociana seleccionados de manera no aleatoria. Resultados : Ambos grupos fueron comparables en edad, sexo, frecuencia de litiasis vesicular y CPRE preoperatoria. El tiempo quirúrgico promedio fue 4,52 versus 3,49 horas para los abordajes laparoscópico y convencional respectivamente. En el grupo laparoscópico se usó tubo de Kehr en 21% de los pacientes y en 79 % sutura primaria. En el grupo convencional se usó tubo de Kehr en 29% de los pacientes y en 71 % sutura primaria. La fuga biliar fue la complicación más frecuente. La estancia hospitalaria fue 3,14 días en el grupo laparoscópico versus 5,23 días en el grupo convencional, sin diferencia estadísticamente significativa. Conclusión : No se logró demostrar una superioridad evidente de alguno de los grupos estudiados, sin embargo nuestros pacientes podrían beneficiarse de las ventajas del abordaje laparoscópico en términos de tener menor dolor postoperatorio y una reincorporación más rápida a sus actividades habituales. Estudios similares con mayor número de casos son necesarios para llegar a datos más concluyentes(AU)

Common bile duct (CBD) lithiasis are an unusual complication associated to gallbladder stones. It can be resolved by endoscopic retrograde cholangiopancreatography (ERCP) or, alternatively, a CBD exploration by conventional (open surgery) or laparoscopic approach.Objectives : To determine the effectiveness of laparoscopic approach versus conventional approach in CBD exploration as a treatment for choledochal lithiasis.Methods : A prospective and comparative study was carried out with a non-random intentionally selected sample consisting of 31 patients with CBD stones.Results : Both groups had no statistical differences regarding age, sex, frequency of gallbladder stones, and preoperatory ERCP. The average surgical time was 4.52 versus 3.49 hours for the laparoscopic and conventional approaches, respectively. In laparoscopic group, Kehr tube was used in 21% of patients and primary closure in 79%. In conventional group, Kehr tube was used in 29% of patients versus 71% of patients with primary closure. Biliary leak was the most frequent complication. Hospital stay was 3.14 days in the laparoscopic group versus 5.23 days in the conventional group, with no statistically significant difference.Conclusion : It was not possible to demonstrate an evident superiority of any of the groups studied, however our patients could benefit from the advantages of the laparoscopic approach in terms of less postoperative pain and faster return to their usual activities. Similar and larger studies are necessary to achieve stronger and conclusive data(AU)

Laparoscopic Roux-en-Y hepaticojejunostomy reconstruction after iatrogenic bile duct injury: case series report.

INTRODUCTION: Bile duct injury (BDI) is a devastating complication after a cholecystectomy. Laparoscopic management has become a mainstay approach because of the advantages offered to patients; nevertheless, outcomes after repair are influenced by the center, the surgeon's experience, and the type of reconstruction. MATERIALS AND METHODS: Patients with common BDI managed at a referral center from January 2013 to June 2018 with a novel modified and simplified laparoscopic technique for a hepatic duct jejunostomy with a Roux-en-Y reconstruction were retrospectively reviewed. RESULTS: Twenty patients had a BDI (20/5430-0.3%), 8 (40%) had intraoperative diagnosis, and 12 (60%) patients with diagnosis before 72 h. Type E Strasberg classification, the predominant BDI was Strasberg E1 (65%), the average surgery time was 146.5 min (115-178 min), the average intraoperative bleeding was 15-50 cc. The overall complication rate was 10 % (2/20), 1 (5%) patient required, there were no mortalities, and the mean hospital stay was 5 days. One (5%) patient presented bile leak (Type SE4), and 1 (5%) patient required intensive care unit admission after reintervention. Long-term follow-up showed no bile duct stricture, cholangitis, or recurrent choledocholithiasis up to 5 years after the procedure and with a minimum of 1 year minimum follow-up. CONCLUSIONS: This simplified laparoscopic approach to bile duct reconstruction with Roux-en-Y anastomoses appears to be an effective and safe alternative to reconstructive open bile duct surgery, offering to patients the benefits of laparoscopic surgery with a low complication rate.

ANTECEDENTES: La lesión del conducto biliar es una complicación devastadora tras una colecistectomía. El tratamiento laparoscópico se ha convertido en un enfoque principal debido a las ventajas ofrecidas a los pacientes; sin embargo, los resultados después de la reparación están influenciados por el centro, la experiencia del cirujano y el tipo de reconstrucción. MÉTODO: Se revisaron retrospectivamente los pacientes con lesión del conducto biliar tratados con reconstrucción biliar en un centro de referencia, desde enero de 2013 hasta junio de 2018, por vía laparoscópica con una técnica modificada y simplificada con hepatoyeyunostomía en Y de Roux. RESULTADOS: Veinte pacientes de 5,430 tenían lesión del conducto biliar (0,3%), 8 (40%) tuvieron diagnóstico intraoperatorio y 12 (60%) diagnóstico antes de las 72 horas. Todos con una clasificación de Strasberg tipo E, con predominio de E1 (65%). El tiempo quirúrgico promedio fue de 146,5 (rango 115-178) minutos y el sangrado intraoperatorio promedio fue de 15-50 cm3. La tasa general de complicaciones fue del 10% (2/20); 1 (5%) paciente requirió reintervención. No hubo mortalidad y la estancia hospitalaria media fue de 5 días. Un paciente (5%) presentó fuga biliar (tipo SE4) y 1 (5%) paciente requirió ingreso en la unidad de cuidados intensivos después de la reintervención. El seguimiento fue de hasta 5 años tras el procedimiento, con un mínimo de 1 año, y no se han documentado estenosis del conducto biliar, colangitis ni coledocolitiasis recurrente. CONCLUSIÓN: Este enfoque laparoscópico simplificado para la reconstrucción del conducto biliar con anastomosis en Y de Roux parece ser una opción efectiva y segura a la cirugía reconstructiva del conducto biliar abierta, ofreciendo a los pacientes los beneficios de la cirugía laparoscópica y con una baja tasa de complicaciones.

Tratamiento laparoscópico de hernia incisional con malla biocompatible de ptfe intraperitoneal / Laparoscopic treatment of incisional hernia with ptfe biological mesh

Una hernia Incisional (HI) puede definirse como cualquier defecto de la pared abdominal, con o sin aumento de volumen, en el área de una cicatriz postoperatoria, perceptible o palpable por el examen clínico o imagenológico(1). La hernioplastía intraperitoneal laparoscópica constituye una opción segura para el tratamiento de hernias incisionales de la pared abdominal, asociada a una baja tasa de recurrencia que alcanza a 6,25% a largo plazo(1). Se presenta un caso de Hernioplastia laparoscópica con colocación de malla de PTFE intraperitoneal, como una alternativa válida para la reparación de hernias incisionales.

An incisional hernia can be defined a s a ny d efect o f t he abdominal wall, with or without an increase in volume, in the area of a postoperative scar, perceptible or palpable by clinical or imaging examination. The l aparoscopic i ntraperitoneal h ernioplasty is a safe option for the treatment of incisional hernias of the abdominal wall, associated with a low recurrence rate that reaches 6.25% in the long term. In this time, a case of laparoscopic hernioplasty with placement of a intraperitoneal PTFE mesh is presented as a valid alternative for the repair of incisional hernias.

[A preliminary experience in the laparoscopic approach to bowel obstruction]. / Experiencia inicial en el abordaje laparoscópico de la obstrucción intestinal.

BACKGROUND: The laparoscopic approach to bowel obstruction is still controversial. OBJECTIVE: To evaluate our initial results in the laparoscopic treatment of bowel obstruction. MATERIAL AND METHODS: A retrospective study on patients diagnosed with bowel obstruction that underwent laparoscopic surgery within the time frame of January 2008 to June 30, 2012. The variables employed were: age, sex, occlusion etiology, previous surgeries, clinical progression, pneumoperitoneum creation, use of an auxiliary incision, anesthesia duration, conversion rate, postoperative hospital stay, time needed to tolerate liquids, and complications. RESULTS: Twenty-six patients, 18 women (69.2%) and 8 men (30.8%), with a mean age of 64.35 years (range: 21-92 years) were analyzed. The most frequent obstruction etiology was secondary to adhesions and presented in 12 cases. Nine patients (34.6%) underwent a completely laparoscopic approach and laparoscopy was complemented by an auxiliary incision in another 9 patients (34.6%), resulting in 18 cases (69.2%) of successful laparoscopic approach. Eight patients (30.8%) required conversion to open surgery. The mean anesthesia duration was 95min (range: 55-165min), mean postoperative hospital stay was 6 days (range: 3-72 days), and the mean amount of time needed to tolerate liquids was 3 days (range: 1-10 days). The patients that underwent complete laparoscopic approach presented with shorter hospital stay, they were able to ingest liquids earlier, and they presented with a lower number of postoperative complications; this latter variable was the only one that was statistically significant. CONCLUSIONS: The initial results of our experience were good, although more patients are needed in order to standardize and extend the use of this technique.

Reconstrucción anatómica laparoscópica en útero unicorne no comunicante / Laparoscopic approach for unicornuate uterus

Las alteraciones congénitas de los conductos de Müller son un amplio grupo de patología, siendo el útero unicorne una de sus manifestaciones.Se relaciona con un aumento de complicaciones obstétricas y a su vez la presencia de un cuerno rudimentario no comunicante, es causa de dolor pélvico crónico. Presentamos una paciente de 14 años aquejada de intensa dismenorrea. Mediante técnicas de imagen se evidencia la presencia de útero unicorne con cuerno rudimentario derecho no comunicante. Se realizó abordaje laparoscópico en la que se procedió a exéresis del cuerno rudimentario y posterior reconstrucción anatómica. La paciente cursó un postoperatorio sin complicaciones, obteniendo una mejoría clínica satisfactoria en sus controles posteriores. El abordaje laparoscópico a las pacientes afectas de útero unicorne no comunicante permite restablecer de forma óptima la anatomía y mejorar la sintomatología asociada. Mediante una correcta técnica laparoscópica se consigue disminuir el riesgo de adherencias posteriores, asegurando una baja tasa de complicaciones y una recuperación funcional postoperatoria precoz.

Congenital anomalies of the Müllerian ducts are a large group of pathology, and unicornuate uterus is one of its manifestations. It is associated with increased obstetric complications and the presence of cavitated non communicating rudimentary uterine which cause chronic pelvic pain. We report a 14 years old patient suffering severe dysmenorrhea. Using imaging techniques showed the presence of unicornuate uterus with non communicating rudimentary right horn. Laparoscopy was performed in which we proceeded to resection of rudimentary horn and subsequent reconstruction of the anatomy. The patient had an uneventful postoperative course, obtaining a satisfactory clinical improvement in subsequent tests. The laparoscopic approach in patients with advanced non-communicating unicornuate uterus can optimally restore the anatomy and improving associated symptoms. A proper laparoscopic approach can lower the risk of subsequent adhesions, and ensure few complications and early postoperative functional recovery.