Complications of Tension-Free Vaginal Tape Surgery: A Multi-Institutional Review

AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors.

METHODS: A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach.

RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described.

CONCLUSION: Along with the traditional cooperative techniques, new procedures like LECS, LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures.

Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status.

Introduction Hydatid disease is an endemic anthropozoonosis with usual localization in liver and lungs. Rarely it localizes in uncommon sites as spleen, skeleton, kidney, brain, cardiac muscle, peritoneum, sub cutis. Complications of uncommon localizations are the same that for usual ones. Material and methods Review of the literature on rare and atypical localization of hydatid cysts in soft tissues. Key-words used on Pub-Med [(echinococ OR hydatid) AND (soft tissue OR subcutaneous OR cutaneous)] without time limit. There were found 282 articles; 242 were excluded because of muscular or bone localizations. 40 were coherent. Results Different variables are taken into account: age, sex, geographic area, anatomic localization of the cyst, dimension, symptoms, signs, mobility, blood exams and specific serological tests, imaging techniques for diagnosis, existing of septa in the structure, treatment, anaesthesia, spillage, neo-adjuvant and adjuvant treatment, follow-up period, recurrent lesions. Conclusion It would be useful create an homogeneous and standardized collection of data of these rare and potentially life-threatening conditions in order to create guide-line of diagnostic and therapeutic process and create (or adopt) unique classification of the lesions.

/pdf/uncommon-localizations-of-hydatid-cyst-review-of-the-fk6260d58x.pdf

Uncommon localizations of hydatid cyst. Review of the literature

The purpose of this research is to study the outcomes of splenectomy for chronic and persistent immune thrombocytopenia (ITP). This study is a retrospective analysis of 254 patients with chronic or persistent ITP who underwent splenectomy at CMC, Vellore, India between 1995 and 2009. Responses were assessed based on standard criteria. One hundred and sixty seven adults and 87 children with a median age of 29 years (range 2–64) with persistent (n = 103) or chronic ITP (n = 151) was studied. Response was seen in 229 (90.2 %) including CR in 74.4 % at a median time of 1 day (range 1–54). Infections following splenectomy were reported in 16 %. Deaths related to post splenectomy sepsis occurred in 1.57 % and major bleeding in 0.78 %. At median follow-up of 54.3 months (range 1–290), 178 (70.1 %) remain in remission. The 5-year and 10-year overall survival (OS) is 97.4 ± 1.2 % and 94.9 ± 2.1 %, respectively, while the 5-year and 10-year event-free survival (EFS) is 76.5 + 2.9 % and 71.0 + 3.9 %, respectively. Splenectomy is associated with long-term remission rates of >70 % in chronic or persistent ITP.

Long-term outcome following splenectomy for chronic and persistent immune thrombocytopenia (ITP) in adults and children

Tension-free vaginal tape for primary genuine stress incontinence: a two-centre follow-up study

Background: Only a few studies have addressed long-term results comparing laparoscopic and open splenectomy in idiopathic thrombocytopenic purpura (ITP). We analyzed the 1-year results comparing age, sex, length of preoperative steroid therapy, diagnosis-to-splenectomy interval, and preoperative platelet count in relation to postoperative response after open and laparoscopic splenectomy. Subjects and Methods: Data collected from two groups, treated by laparoscopic and open splenectomy, respectively, of 20 patients each were retrospectively reviewed. Positive response to splenectomies, evaluated according to the International Working Group guidelines reported by the American Society of Hematology, was statistically related through Student's t test and the Pearson correlation test to the above-mentioned factors. Results: Positive response to splenectomy was observed in 80% and 85% of patients, respectively, in the laparoscopic and open groups (P>.10). No statistical differences were observed compar...

Long-term results after splenectomy in adult idiopathic thrombocytopenic purpura: comparison between open and laparoscopic procedures.

Solitary subcutaneous hydatid cyst: review of the literature and report of a new case in the deltoid region.

The Authors describe the techniques they perform of prepubic, retropubic and transobturator mini-invasive anti-incontinence surgical procedures and point-out some technical details. The state of art and the results of these three main surgical procedure are compared and discussed. Data from the Literature have been reviewed in order to evaluate the efficacy of the techniques. A Medline search has been performed, and 65 relevant articles from 1996 to 2012 were selected. Literature showed similar cure rates among retropubic (71,4-91%), trans-oburator (77,3-95%) and prepubic (81-87,2%) anti-incontinence procedures. Cystoscopy was considered necessary in the retropubic, optional in transobturator and in the prepubic techniques. Intra-operative cough stress test was believed useful only in the retropubic and prepubic procedures. Obstruction symptoms prevailed in the retropubic, were rare in the transobturator and missing in the prepubic technique. Erosion rate was very low and similar for all the three techniques. Intra-operative vascular and perforating risks prevailed in the retropubic technique, due to the danger present in the retropubic space, whereas late infective complications overcame in the transobturator procedure. Severe complications in the prepubic procedure were not reported, but the procedure is performed only in few centers.

Mini-invasive tension-free surgery for female urinary incontinence.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and they often require a surgical removal. Gastrointestinal stromal tumors can originate from any part of the gastrointestinal tract but gastric location is the most common. In the past the risk of rupture of pseudocapsula and peritoneal dissemination have discouraged surgeons from making a minimally invasive surgical treatment. Recently laparoscopic wedge resection has been proposed. Performance of this mini-invasive technique is however difficult in some gastric location of gastrointestinal stromal tumors, such as iuxta-cardial region. The Authors report and discuss a new technique they used to remove a gastrointestinal stromal tumor located just below the cardia, using a rendez-vous endoscopic and laparoscopic technique.

/pdf/laparoscopic-endoscopic-rendez-vous-resection-of-iuxta-2bxuo7hlvk.pdf

Laparoscopic-endoscopic rendez-vous resection of iuxta-cardial gastric GIST.

We read with interest the article by K. De Vogelaere, Laparoscopic resection of gastric gastrointestinal stromal tumors (GIST) is safe and effective, irrespective of tumor size, published in Surgical Endoscopy 2012;26:2339–2345. We agree with the authors that the laparoscopic approach can be safely and effectively used to remove gastric stromal tumors irrespective of tumor size. Data from the literature show that the long-term results of the laparoscopic procedure are comparable with those reported after traditional open resection of gastric GIST [1–6]. Concerning the technique described by the authors, we think that for tumor located in the anterior wall, the wedge resection is the best technique to be used. For tumors located in the posterior wall, the technique described in the article is a good option for large tumors. For endophitic small tumors of the posterior stomach wall, however, another laparoscopic approach can be used. We have experienced and published an endoscopic–laparoscopic approach that allowed us to perform a mini-invasive surgery for tumors smaller than 2 cm in diameter located in the posterior wall of the stomach. By our proposed technique, laparoscopic removal of GIST was performed also for a patient with a tumor located close to the esophagogastric junction, which the authors ruled out in their series, probably because these tumors are technically challenging with the laparoscopic approach they reported. The technique we have published was performed using two 5-mm radially expandable trocars inserted through the abdominal and gastric walls to have very small incisions in the gastric wall. An endoscopic polipectomy snare introduced per mouth was maneuvered by an endoscopist, who grasped and tractioned the gastric iuxtacardial lesion. A harmonic scalpel device inserted through the 5-mm laparoscopic trocar was used to remove the gastric tumor with a submucosal resection. The resection of the lesion was accomplished thanks to the traction made by the endoscopist through the polipectomy snare, which allowed an excellent exposure of the dissection site. The specimen then was pulled away from the mouth after its introduction into a small plastic bag. After withdrawal of the expandable trocars, the gastric holes were closed with monofilament nonabsorbable sutures. A nasogastric tube was left in place for 2 days. The postoperative phase was uneventful. This laparoscopic–endoscopic technique made possible a complete resection of the submucosal GIST, which otherwise could have been more challenging with marked intraoperative risk of complications (e.g., perforation), considering the iuxtacardial location of the tumor. Our technique allows all the advantages of the laparoscopic surgery, avoids the gastrotomy, and at the same time satisfies the principles of oncologic surgery. In addition, GIST located in the iuxtacardial region may be resected safely and with less morbidity than with other laparoscopic or open approaches.

Combined laparoscopic and endoscopic excision of a gastric gist.

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