Leiomyosarcoma of the Mesentery.

The mesentery is a common site of metastasis from gastrointestinal, pancreatic, and biliary cancers. Primary mesenteric cancers are rare and usually mesenchymal and benign. Mesenteric leiomyosarcoma is a rare, malignant smooth muscle sarcoma with an incidence of 1:350000. It usually arises from the vasculature of the mesentery. The ileum of the small bowel is the most common site of origin. Due to its low incidence, preoperative diagnosis is difficult. This is a report of a 71-year-old woman who presented with several months of a lower abdominal mass and recent onset of associated abdominal discomfort. An earlier colonoscopy 8 months previously was unremarkable. A recent abdominal and pelvic computed tomography scan revealed a necrotic mass in the central mesentery. She underwent surgical resection of the mass to include the overlying segment of the small intestine and had an uneventful convalescence. Mesenteric leiomyosarcoma is a rare tumor that is diagnosed based on histological examination with immunohistochemistry. As a result, there is minimal information on its clinical presentation, pathology, and treatment.

Single-incision laparoscopic cholecystectomy is feasible: initial experience with 80 cases.

BACKGROUND AND OBJECTIVE: Single-incision laparoscopic surgery (SILS) is a new advance wherein laparoscopic surgery is carried out through a single small incision hidden in the umbilicus. Advantages of this technique over standard laparoscopy are still under investigation. The objective of this study is to describe the short-term outcomes of SILS cholecystectomy in a single community-based institution. METHODS: A retrospective review of a prospectively collected database for all patients who underwent SILS cholecystectomy was carried out. Both true single-incision and dual-incision (training) cases were included in the analysis. Operative and perioperative outcomes were analyzed. RESULTS: Eighty SILS cholecystectomies (4 dual incision and 76 single incision) were performed from May 30, 2008 to April 23, 2009 (indications: 48 stones, 20 cholecystitis, 11 biliary dyskinesia, and 1 polyp). Mean body mass index (BMI) was 26.5 kg/m(2) (range 17.3-39.1 kg/m(2)), mean operating room (OR) time was 69.5 min (range 29-126 min), mean estimated blood loss (EBL) was 5 cc, and mean incision length was 1.6 cm. There were no open conversions, but there were six conversions to dual-port and three conversions to four-port laparoscopic cholecystectomy due to poor visualization. Complications include three bile leaks managed with endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous drainage (3.7%). Two leaks were from accessory ducts and one was from a cystic duct stump. Number of days of postoperative oral narcotic use was described as none in 11 patients (23%), minimal (1 day) in 21 patients (45%), moderate (1-3 days) in 6 patients (13%), and heavy (≥ 4 days) in 9 patients (19%), with mean follow-up of 4.7 months in 60 patients. CONCLUSION: SILS cholecystectomy is feasible, with acceptable morbidity. Although not directly compared in this study, postoperative recovery appears shorter than after standard laparoscopy, but more studies are needed.