Safety and feasibility of repeat laparoscopic colorectal resection: a matched case-control study.

BACKGROUND: Perioperative outcomes of repeat laparoscopic colorectal resection (LCRR) have not been extensively reported. METHODS: Patients who underwent LCRR from 2010 to 2018 in an expert center were retrieved from a prospectively collected database and compared to 2:1 matched sample. Matching was based on demographics, surgical indication [colorectal cancer (CRC) or benign condition], and type of resection (right-sided resection or left-sided resection or proctectomy). RESULTS: Twenty-three patients underwent repeat LCRR with a median time of 36 months between the primary and the repeat LCRR. They were 12 (52%) men with a mean age of 64.9 years (31-87) and a median BMI of 21.4 kg/m2 (17.7-34). Indication for repeat LCRR was CRC, dysplasia, anastomotic stricture, and inflammatory bowel disease in 11 (48%), 5 (22%), 4 (17%), and 3 (13%) patients, respectively. A right-sided resection, a left-sided resection, and proctectomy were reported in 11 (48%), 8 (35%), and 4 (17%) patients, respectively. Median blood loss reached 211 mL (range 0-2000 mL). Thirteen (57%) patients required conversion to laparotomy including 12 for intense adhesions. The median length of hospital stay was 7.5 days (5-20). Two (9%) major complications (Clavien-Dindo ≥ 3) were reported: 1 (4%) anastomotic fistula and 1 (4%) postoperative hemorrhage, without mortality. Among patients who underwent repeat LCRR for CRC, histopathological examination showed R0 resection in all patients, with at least 12 lymph nodes harvested in ten (91%) patients. After matched case-control analysis that compared to primary LCRR, conversion rate (p = 0.03), operative time (p = 0.03), and intraoperative blood loss (p = 0.0016) were significantly increased in repeat LCRR, without impact on postoperative outcomes. CONCLUSIONS: Repeat LCRR seems to be feasible and safe in expert hands without compromising the oncologic outcomes. Intense postoperative adhesions and misidentification of blood supply might lead to conversion to laparotomy. Real benefits of laparoscopic approach for repeat LCRR should be assessed in further studies.

Laparoscopic management of sigmoid colon gallstone ileus.

Gallstone ileus is an uncommon clinical presentation of complicated biliary lithiasis that mostly occurs in the elderly without specific signs. Various types of surgical management have been proposed: primary enterolithotomy, enterolithotomy, cholecystectomy and fistula closure (one stage), or enterolithotomy with delayed cholecystectomy (two stage). All are associated with a high complication rate. We present a video of a laparoscopic cololithotomy for gallstone ileus caused by a gallstone impacted in the sigmoid colon. As a safe and feasible procedure, enterolithotomy appears to be the treatment of choice based on the scientific literature, especially in frail patients. However, except in case of an impacted gallstone in a colorectal cancer, colon resection is not mandatory. Further surgery (such as cholecystectomy or colectomy in benign disease such as diverticulosis) may be selectively considered.

Laparoscopic extended liver resection: are postoperative outcomes different?

BACKGROUND: Although laparoscopic major hepatectomy (LMH) is becoming increasingly common in specialized centers, data regarding laparoscopic extended major hepatectomies (LEMH) and their outcomes are limited. The aim of this study was to compare the perioperative characteristics and postoperative outcomes of LEMH to standard LMH. METHODS: All patients who underwent purely laparoscopic anatomical right or left hepatectomy and right or left trisectionectomy between February 1998 and January 2016 are enrolled. Demographic, clinicopathological, and perioperative factors were collected prospectively and analyzed retrospectively. Perioperative characteristics and postoperative outcomes in LEMH were compared to those of standard LMH. RESULTS: Among 195 patients with LMH, 47 (24.1%) underwent LEMH, colorectal liver metastases representing 66.7% of all indications. Preoperative portal vein embolization was undertaken in 31 (15.9%) patients. Despite more frequent vascular clamping, blood loss was higher in LEMH group (400 vs. 214 ml; p = 0.006). However, there was no difference in intraoperative transfusion requirements. Thirty-one patients experienced liver failure with no differences between LMH and LEMH groups. Postoperative mortality was comparable in the two groups [3 (2.5%) LMH patients vs. 2 (5%) LEMH patients (p = 0.388)]. Overall morbidity was higher in the LEMH group [49 LMH patients (41.5%) vs. 24 LEMH patients (60%) (p = 0.052)]. Patients treated with left LEMH experienced more biliary leakage (p = 0.011) and more major pulmonary complications (p = 0.015) than left LMH. CONCLUSION: LEMH is feasible at the price of important morbidity, with manageable and acceptable outcomes. These exigent procedures require high-volume centers with experienced surgeons.

Giant Filiform Polyposis not Associated with Inflammatory Bowel Disease: A Case Report.

BACKGROUND: Filiform polyposis (FP) is an uncommon cause of non-neoplastic and non-syndromic polyposis. Several hypotheses concerning its pathogenesis have been published. FP is most frequently associated with a post-inflammatory reparative process; indeed, the most frequent association is with inflammatory bowel disease (IBD). FP is characterized by one to hundreds of uniform, slender, arborizing, vermiform projections of the large bowel mucosa and submucosa lined by normal or inflamed colonic mucosa. The most common sites for these polyps are the transverse and descending colon. CASE REPORT: In this report we present a case of giant FP associated with locally invasive adenocarcinoma of the right colon in a 73-year-old man with no past medical history of IBD. CONCLUSION: Few of these cases have been reported in the literature, and out of the approximately 20 of such case reports only one other was associated with colorectal adenocarcinoma.