Objective: This study aimed to demonstrate the feasibility of laparoscopic-resection of the abdominal cystic lymphangiomas in Pediatric Surgery and describe the morbidity associated to this management in Queen fabiola...Objective: This study aimed to demonstrate the feasibility of laparoscopic-resection of the abdominal cystic lymphangiomas in Pediatric Surgery and describe the morbidity associated to this management in Queen fabiola children’s university hospital (HUDERF) in Brussels. Methods: We retrospectively conducted a study at the Pediatric Surgery Department of HUDERF, Brussels. The studied period was from January 1, 2014, to January 1, 2024;a span of 10 years. All patients with a confirmed diagnosis of cystic lymphangiomas and who underwent laparoscopic surgery were included in our study. Those who have been operated exclusively by open surgery have been excluded. The technique involved either total laparoscopic resection or laparoscopic-assisted with extra-abdominal resection of the tumor. Parameters that were studied included age, sex, weight, symptoms, preoperative diagnosis, imaging assessment, location, size of the tumor, type of mass, surgical procedure, duration of the surgery, conversion to open surgery, morbidity, and histopathology. Data were analyzed using Microsoft Office Excel 2010 and SPSS. Results: We retrieved 10 files of patients presenting with abdominal cystic lymphangiomas within two patients underwent exclusive open surgery and have excluded from our study. Then our sample was constituted with 8 patients. The mean age of the patients was 6.4 years (standard deviation: 3.6 years, range: 1 to 11 years). Male patients were predominant. The mean weight was 26.7 kg (standard deviation: 14.7 kg, range: 10 to 55 kg). The most common symptom was abdominal pain. Preoperative diagnosis of abdominal cystic lymphangioma was made in 8 cases. Abdominal ultrasound was performed in all patients. MRI was done in 5 patients, and CT scan in 2 patients. All patients presented a multicystic mass. Pure laparoscopic resection of the cyst was done in 2 cases. Laparoscopic-assisted resection in 4 cases (with extra-peritoneal with small bowel resection and mesenteric detorsion in 1 case), and conversion in 2 cases due to the complex location of the cyst. After a follow-up period of 5 years, morbidity was noted in one patient (Patient 3) who developed postoperative bowel obstruction 1 month post-surgery. This patient was re-operated on with a favorable clinical outcome following conventional small bowel resection and anastomosis. The other patients (1, 2, 4, 5, 6, 7 and 8) had a simple clinical course, and no recurrence was observed in our series. Conclusion: Laparoscopic-resection of the abdominal cystic lymphangiomas is feasible in Pediatric Surgery. As minimally invasive surgery it gives many advantages even for complex abdominal cystic lymphangiomas with less morbidity as shown in our series.展开更多
AIM： Since 1987, laparoscopic cholecystectomy （LC） has been widely used as the favored treatment for gallbladder lesions. Cholecystoenteric fistula （CF） is an uncommon complication of the gallbladder disease, whi...AIM： Since 1987, laparoscopic cholecystectomy （LC） has been widely used as the favored treatment for gallbladder lesions. Cholecystoenteric fistula （CF） is an uncommon complication of the gallbladder disease, which has been one of the reasons for the conversion from LC to open cholecystectomy. Here, we have reported four cases of CF managed successfully by laparoscopic approach without conversion to open cholecystectomy. METHODS： During the 4-year period from 2000 to 2004, the medical records of the four patients with CF treated successfully with laparoscopic management at the Chang Gung Memorial HospitaI-Taipei were retrospectively reviewed. RESULTS： The study comprised two male and two female patients with ages ranging from 36 to 74 years （median： 53.5 years）. All the four patients had right upper quadrant pain. Two of the four patients were detected with pneumobilia by abdominal ultrasonography. One patient was diagnosed with cholecystocolic fistula preoperatively correctly by endoscopic retrograde cholangiopancreatography and the other one was diagnosed as cholecystoduodenal fistula by magnetic resonance cholangiopancreatography. Correct preoperative diagnosis of CF was made in two of the four patients with 50% preoperative diagnostic rate. All the four patients underwent LC and closure of the fistula was carried out by using Endo-GIA successfully with uneventful postoperative courses. The hospital stay of the four patients ranged from 7 to 10 d （median, 8 d）. CONCLUSION： CF is a known complication of chronic gallbladder disease that is traditionally considered as a contraindication to LC. Correct preoperative diagnosis of CF demands high index of suspicion and determines the success of laparoscopic management for the subset of patients. The difficult laparoscopic repair is safe and effective in the experienced hands of laparoscopic surgeons.展开更多
1.Introduction Initially,in vitro fertilization and embryo transfer(IVF-ET)was designed to solve tubal factors infertility(TFI)by placing the embryo(s)within the uterine cavity.However,in some cases,an ectopic implant...1.Introduction Initially,in vitro fertilization and embryo transfer(IVF-ET)was designed to solve tubal factors infertility(TFI)by placing the embryo(s)within the uterine cavity.However,in some cases,an ectopic implantation occurs as the embryo can enter the tube.Ectopic pregnancy(EP)is the location of the pregnancy outside the intrauterine cavity.The prevalence of EP following assisted reproductive technology(ART)ranges between 2.1%and 8.6%of all pregnancies and it can reach up to 11%inwomen with tubal factors infertility history.展开更多
The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage procedure.It basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)...The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage procedure.It basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)exploration(LCBDE)in the same operation or LC with preoperative,postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy(ERCP-ES)for stone clearance.The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC,preferably on the next day.In cases where preoperative ERCP-ES is not feasible,the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated.The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES.However,there is no consensus on the superiority of laparoendoscopic rendezvous.This is equivalent to a traditional two-stage procedure.Endoscopic papillary large balloon dilation reduces recurrence.LCBDE and intraoperative ERCP have similar good outcomes.The risk of recurrence after ERCP-ES is greater than that after LCBDE.Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones.The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage,but the transcystic approach must be used where possible.LCBDE is a safe and effective choice when performed by an experienced surgeon.However,the requirement of specific equipment and advanced training are drawbacks.The percutaneous approach is an alternative when ERCP fails.Surgical or endoscopic reintervention for retained stones may be needed.For asymptomatic CBD stones,ERCP clearance is the firstchoice method.Both one-stage and two-stage management are acceptable and can ensure improved quality of life.展开更多
AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a publi...AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography(CT)].Patients with gallbladder cancer(GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival(DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients(11 women and eight men) were found to have GBC.The male to female ratio was 1:1.4 and the mean age was 68 years(range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis(1),pT1a(2),pT1b(4),pT2(6),pT3(4),pT4(2);five cases with stageⅠa(T1 a-b);two with stageⅠb(T2 N0);one with stage Ⅱa(T3 N0);six with stage Ⅱb(T1-T3 N1);two with stage Ⅲ(T4 Nx Nx);and one with stage Ⅳ(Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage(≤Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT(nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum(one case),porcelain gallbladder(one case),gallbladder adenoma(one case),and chronic cholelithiasis(eight cases).Every case,except one,with a T1b or more advanced invasion underwent Ⅳb + Ⅴ wedge liver resection and pericholedochic/hepatoduodenal lymphadenectomy.One patient with stage T1b GBC refused further surgery.Cases with Tis and T1a involvement were treated with cholecystectomy alone.One incidental case was diagnosed by intraoperative frozen section and treated with cholecystectomy alone.Six of the nine patients with incidental diagnosis reached 5-year DFS.One patient reached 38 mo survival despite a port-site recurrence 2 years after original surgery.Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5-year DFS.CONCLUSION:Laparoscopic cholecystectomy does not affect survival if implemented properly.Reoperation should have two objectives:R0 resection and clearance of the lymph nodes.展开更多
BACKGROUND Choledocholithiasis is a common benign disease of the biliary tract.We identified a particular type of choledocholithiasis characterized by sudden narrowing of the common bile duct at the site of impaction,...BACKGROUND Choledocholithiasis is a common benign disease of the biliary tract.We identified a particular type of choledocholithiasis characterized by sudden narrowing of the common bile duct at the site of impaction,which caused a marked increase in surgical difficulty and risk compared to treatment for typical choledocholithiasis.This phenomenon has not been described in previous studies.AIM To propose the ice-breaking sign and evaluate its influence on treatment strategies for choledocholithiasis.METHODS Using a retrospective case-control study design,patients who were diagnosed with common bile duct stones and admitted to the Emergency Department of Peking University Third Hospital between January 2018 and December 2023 were included.Propensity score matching was used to match cases and controls.Univariate analysis was conducted to assess the differences in clinical data between the two groups of patients.RESULTS There were no significant differences in the baseline data between the two groups,except for higher incidence of jaundice,alkaline phosphatase and total bilirubin in the ice-breaking sign group.Compared to the control group,the ice-breaking sign group had lower success rates for endoscopic retrograde cholangiopancreatography(25.0%vs 81.8%,P=0.006)and laparoscopic common bile duct exploration(69.4%vs 93.8%,P=0.007),longer operation time(148.04±60.55 minutes vs 106.15±35.21 minutes,P=0.001),higher likelihood of T-tube placement(62.2%vs 31.3%,P=0.016)and using lithotripsy techniques during surgery(29.7%vs 0%,P=0.001),more intraoperative bleeding[25.0(20.0-50.0)mL vs 10.0(10.0-20.0)mL,P<0.001]and longer postoperative hospital stay[6.50(5.0-9.0)days vs 5.50(3.0-6.50)days,P=0.002].The ice-breaking sign group showed significantly more dilatation in the proximal than distal bile duct.CONCLUSION The ice-breaking sign,a newly identified radiological phenomenon,may influence therapeutic decisions in choledocholithiasis,suggesting laparoscopic common bile duct exploration as the preferred approach over endoscopic retrograde cholangiopancreatography in patients exhibiting this sign.展开更多
文摘Objective: This study aimed to demonstrate the feasibility of laparoscopic-resection of the abdominal cystic lymphangiomas in Pediatric Surgery and describe the morbidity associated to this management in Queen fabiola children’s university hospital (HUDERF) in Brussels. Methods: We retrospectively conducted a study at the Pediatric Surgery Department of HUDERF, Brussels. The studied period was from January 1, 2014, to January 1, 2024;a span of 10 years. All patients with a confirmed diagnosis of cystic lymphangiomas and who underwent laparoscopic surgery were included in our study. Those who have been operated exclusively by open surgery have been excluded. The technique involved either total laparoscopic resection or laparoscopic-assisted with extra-abdominal resection of the tumor. Parameters that were studied included age, sex, weight, symptoms, preoperative diagnosis, imaging assessment, location, size of the tumor, type of mass, surgical procedure, duration of the surgery, conversion to open surgery, morbidity, and histopathology. Data were analyzed using Microsoft Office Excel 2010 and SPSS. Results: We retrieved 10 files of patients presenting with abdominal cystic lymphangiomas within two patients underwent exclusive open surgery and have excluded from our study. Then our sample was constituted with 8 patients. The mean age of the patients was 6.4 years (standard deviation: 3.6 years, range: 1 to 11 years). Male patients were predominant. The mean weight was 26.7 kg (standard deviation: 14.7 kg, range: 10 to 55 kg). The most common symptom was abdominal pain. Preoperative diagnosis of abdominal cystic lymphangioma was made in 8 cases. Abdominal ultrasound was performed in all patients. MRI was done in 5 patients, and CT scan in 2 patients. All patients presented a multicystic mass. Pure laparoscopic resection of the cyst was done in 2 cases. Laparoscopic-assisted resection in 4 cases (with extra-peritoneal with small bowel resection and mesenteric detorsion in 1 case), and conversion in 2 cases due to the complex location of the cyst. After a follow-up period of 5 years, morbidity was noted in one patient (Patient 3) who developed postoperative bowel obstruction 1 month post-surgery. This patient was re-operated on with a favorable clinical outcome following conventional small bowel resection and anastomosis. The other patients (1, 2, 4, 5, 6, 7 and 8) had a simple clinical course, and no recurrence was observed in our series. Conclusion: Laparoscopic-resection of the abdominal cystic lymphangiomas is feasible in Pediatric Surgery. As minimally invasive surgery it gives many advantages even for complex abdominal cystic lymphangiomas with less morbidity as shown in our series.
文摘AIM： Since 1987, laparoscopic cholecystectomy （LC） has been widely used as the favored treatment for gallbladder lesions. Cholecystoenteric fistula （CF） is an uncommon complication of the gallbladder disease, which has been one of the reasons for the conversion from LC to open cholecystectomy. Here, we have reported four cases of CF managed successfully by laparoscopic approach without conversion to open cholecystectomy. METHODS： During the 4-year period from 2000 to 2004, the medical records of the four patients with CF treated successfully with laparoscopic management at the Chang Gung Memorial HospitaI-Taipei were retrospectively reviewed. RESULTS： The study comprised two male and two female patients with ages ranging from 36 to 74 years （median： 53.5 years）. All the four patients had right upper quadrant pain. Two of the four patients were detected with pneumobilia by abdominal ultrasonography. One patient was diagnosed with cholecystocolic fistula preoperatively correctly by endoscopic retrograde cholangiopancreatography and the other one was diagnosed as cholecystoduodenal fistula by magnetic resonance cholangiopancreatography. Correct preoperative diagnosis of CF was made in two of the four patients with 50% preoperative diagnostic rate. All the four patients underwent LC and closure of the fistula was carried out by using Endo-GIA successfully with uneventful postoperative courses. The hospital stay of the four patients ranged from 7 to 10 d （median, 8 d）. CONCLUSION： CF is a known complication of chronic gallbladder disease that is traditionally considered as a contraindication to LC. Correct preoperative diagnosis of CF demands high index of suspicion and determines the success of laparoscopic management for the subset of patients. The difficult laparoscopic repair is safe and effective in the experienced hands of laparoscopic surgeons.
文摘1.Introduction Initially,in vitro fertilization and embryo transfer(IVF-ET)was designed to solve tubal factors infertility(TFI)by placing the embryo(s)within the uterine cavity.However,in some cases,an ectopic implantation occurs as the embryo can enter the tube.Ectopic pregnancy(EP)is the location of the pregnancy outside the intrauterine cavity.The prevalence of EP following assisted reproductive technology(ART)ranges between 2.1%and 8.6%of all pregnancies and it can reach up to 11%inwomen with tubal factors infertility history.
文摘The management policy of concomitant cholelithiasis and choledocholithiasis is based on a one-or two-stage procedure.It basically includes either laparoscopic cholecystectomy(LC)with laparoscopic common bile duct(CBD)exploration(LCBDE)in the same operation or LC with preoperative,postoperative and even intraoperative endoscopic retrograde cholangiopancreatography-endoscopic sphincterotomy(ERCP-ES)for stone clearance.The most frequently used worldwide option is preoperative ERCP-ES and stone removal followed by LC,preferably on the next day.In cases where preoperative ERCP-ES is not feasible,the proposed alternative of intraoperative rendezvous ERCP-ES simultaneously with LC has been advocated.The intraoperative extraction of CBD stones is superior to postoperative rendezvous ERCP-ES.However,there is no consensus on the superiority of laparoendoscopic rendezvous.This is equivalent to a traditional two-stage procedure.Endoscopic papillary large balloon dilation reduces recurrence.LCBDE and intraoperative ERCP have similar good outcomes.The risk of recurrence after ERCP-ES is greater than that after LCBDE.Laparoscopic ultrasonography may delineate the anatomy and detect CBD stones.The majority of surgeons prefer the transcductal instead of the transcystic approach for CBDE with or without T-tube drainage,but the transcystic approach must be used where possible.LCBDE is a safe and effective choice when performed by an experienced surgeon.However,the requirement of specific equipment and advanced training are drawbacks.The percutaneous approach is an alternative when ERCP fails.Surgical or endoscopic reintervention for retained stones may be needed.For asymptomatic CBD stones,ERCP clearance is the firstchoice method.Both one-stage and two-stage management are acceptable and can ensure improved quality of life.
文摘AIM:To evaluate the impact of incidental gallbladder cancer on surgical experience.METHODS:Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery,one university based and one at a public hospital,were retrospectively reviewed.Gallbladder pathology was diagnosed by history,physical examination,and laboratory and imaging studies [ultrasonography and computed tomography(CT)].Patients with gallbladder cancer(GBC) were further analyzed for demographic data,and type of operation,surgical morbidity and mortality,histopathological classification,and survival.Incidental GBC was compared with suspected or preoperatively diagnosed GBC.The primary endpoint was diseasefree survival(DFS).The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.RESULTS:Nineteen patients(11 women and eight men) were found to have GBC.The male to female ratio was 1:1.4 and the mean age was 68 years(range:45-82 years).Preoperative diagnosis was made in 10 cases,and eight were diagnosed postoperatively.One was suspected intraoperatively and confirmed by frozen sections.The ratio between incidental and nonincidental cases was 9/19.The tumor node metastasis stage was:pTis(1),pT1a(2),pT1b(4),pT2(6),pT3(4),pT4(2);five cases with stageⅠa(T1 a-b);two with stageⅠb(T2 N0);one with stage Ⅱa(T3 N0);six with stage Ⅱb(T1-T3 N1);two with stage Ⅲ(T4 Nx Nx);and one with stage Ⅳ(Tx Nx Mx).Eighty-eight percent of the incidental cases were discovered at an early stage(≤Ⅱ).Preoperative diagnosis of the 19 patients with GBC was:GBC with liver invasion diagnosed by preoperative CT(nine cases),gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum(one case),porcelain gallbladder(one case),gallbladder adenoma(one case),and chronic cholelithiasis(eight cases).Every case,except one,with a T1b or more advanced invasion underwent Ⅳb + Ⅴ wedge liver resection and pericholedochic/hepatoduodenal lymphadenectomy.One patient with stage T1b GBC refused further surgery.Cases with Tis and T1a involvement were treated with cholecystectomy alone.One incidental case was diagnosed by intraoperative frozen section and treated with cholecystectomy alone.Six of the nine patients with incidental diagnosis reached 5-year DFS.One patient reached 38 mo survival despite a port-site recurrence 2 years after original surgery.Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5-year DFS.CONCLUSION:Laparoscopic cholecystectomy does not affect survival if implemented properly.Reoperation should have two objectives:R0 resection and clearance of the lymph nodes.
基金Supported by Clinical Cohort Construction Program of Peking University Third Hospital,No.BYSYDL2023005Peking University Third Hospital Innovation Transformation Fund,No.BYSYZHZB2023105.
文摘BACKGROUND Choledocholithiasis is a common benign disease of the biliary tract.We identified a particular type of choledocholithiasis characterized by sudden narrowing of the common bile duct at the site of impaction,which caused a marked increase in surgical difficulty and risk compared to treatment for typical choledocholithiasis.This phenomenon has not been described in previous studies.AIM To propose the ice-breaking sign and evaluate its influence on treatment strategies for choledocholithiasis.METHODS Using a retrospective case-control study design,patients who were diagnosed with common bile duct stones and admitted to the Emergency Department of Peking University Third Hospital between January 2018 and December 2023 were included.Propensity score matching was used to match cases and controls.Univariate analysis was conducted to assess the differences in clinical data between the two groups of patients.RESULTS There were no significant differences in the baseline data between the two groups,except for higher incidence of jaundice,alkaline phosphatase and total bilirubin in the ice-breaking sign group.Compared to the control group,the ice-breaking sign group had lower success rates for endoscopic retrograde cholangiopancreatography(25.0%vs 81.8%,P=0.006)and laparoscopic common bile duct exploration(69.4%vs 93.8%,P=0.007),longer operation time(148.04±60.55 minutes vs 106.15±35.21 minutes,P=0.001),higher likelihood of T-tube placement(62.2%vs 31.3%,P=0.016)and using lithotripsy techniques during surgery(29.7%vs 0%,P=0.001),more intraoperative bleeding[25.0(20.0-50.0)mL vs 10.0(10.0-20.0)mL,P<0.001]and longer postoperative hospital stay[6.50(5.0-9.0)days vs 5.50(3.0-6.50)days,P=0.002].The ice-breaking sign group showed significantly more dilatation in the proximal than distal bile duct.CONCLUSION The ice-breaking sign,a newly identified radiological phenomenon,may influence therapeutic decisions in choledocholithiasis,suggesting laparoscopic common bile duct exploration as the preferred approach over endoscopic retrograde cholangiopancreatography in patients exhibiting this sign.
