Simultaneous laparoscopic hiatal hernia repair and pyloroplasty for a type 3 hiatal hernia with post-ESD pyloric stenosis for early gastric cancer

We present a case of early gastric cancer in the pylorus with a type 3 hiatal hernia, which was treated by endoscopic submucosal dissection (ESD). A 70-year-old man was referred to our hospital with a hiatal hernia. Endoscopy revealed early gastric cancer, and we performed an ESD adaptation at the pylorus. The ESD was successful, but post-ESD pyloric stenosis occurred. Symptoms of hiatal hernia worsened because of the pyloric stenosis. Laparoscopic hiatal hernia repair with Toupet fundoplication and Heineke-Mikulicz pyloroplasty was simultaneously performed. The postoperative course was good, and follow-up after discharge was uneventful. To our knowledge, there have been no reports in which laparoscopic hiatal hernia repair, fundoplication, and pyloroplasty were simultaneously performed for a substantial hiatal hernia with post-ESD pyloric stenosis.     

Application of laparoscopic distal pancreatectomy for normal anatomy after hiatal hernia repair: A case report

We describe a case of pancreatic tumor associated with a giant type IV hiatal hernia that had prolapsed into the posterior mediastinum. Hiatal hernia repair should be performed first because it enables laparoscopic distal pancreatectomy to be performed in the normal anatomical position.     

腹腔镜手术治疗巨大食管裂孔疝(附6例报告)

目的探讨腹腔镜手术修补巨大食管裂孔疝的临床价值。方法该科2001年10月~2005年3月共收治6倒巨大食管裂孔疝病人，采用腹腔镜手术修补巨大食管裂孔疝＋胃底折叠术（Toupet）。其中气腹腹腔镜手术5倒。非气腹腹腔镜手术1倒。结果手术150—275min，平均214rain，术中出血20-40mL，平均30mL。术后12～24h患者排气，6—12h拔除胃管。术后第1天进流食，病人无吞咽困难。术后7—9d出院。出院后停用抑酸剂。随访6～36个月症状无复发。结论腹腔镜手术修补巨大食管裂孔疝具有创伤小、恢复快和疗效好等优势。     

Single-incision laparoscopic repair for a Morgagni hernia: A case report

A Morgagni hernia is a rare type of congenital diaphragmatic hernia. Here, a case of a Morgagni hernia repaired by SILS is presented. A 78-year-old woman was admitted to our hospital with nausea and vomiting. On CT, the transverse colon and antrum of the stomach were prolapsed into the right thoracic cavity. The herniated stomach was repositioned by emergency endoscopy, and SILS repair was performed electively. Laparoscopy showed the hernial orifice, which was 75 × 50 mm in diameter, on the right side and behind the sternum. Although the transverse colon had herniated through the defect into the right diaphragm, it was easily reduced into the abdominal cavity. Composite mesh was sutured to cover the hernial orifice. No perioperative complications or hernia recurrence have been observed in the 8 months since the surgery.     

腹腔镜食管裂孔疝修补术联合不同抗反流术式治疗食管裂孔疝合并胃食管反流病的临床比较

目的探讨并比较腹腔镜食管裂孔疝修补术联合不同抗反流术式治疗食管裂孔疝(HH)合并胃食管反流病(GERD)的效果。方法回顾性分析该院2014年1月-2017年1月行腹腔镜食管裂孔疝修补术联合抗反流术治疗的HH合并GERD患者67例的病例资料。根据抗反流术式的方法分为3组,其中29例采用腹腔镜Nissen胃底折叠术(Nissen组),18例行腹腔镜Toupet胃底折叠术(Toupet组),20例行腹腔镜Dor胃底折叠术(Dor组)。比较3组手术情况及术后恢复情况,术后随访1年,观察手术前后胃镜、高分辨率食管测压及24 h食管pH监测结果,发放GERD-Q症状评分评估患者GERD症状,使用GERD相关生命质量量表(GERD-HROL),记录两组术后并发症发生率、手术失效率及复发率。结果 3组患者手术情况、术后恢复情况及术后第1年胃镜检查情况比较,差异均无统计学意义(P0.05);Toupet组术后1年食管下括约肌(LES)静息呼吸平均值低于Nissen组和Dor组,反流时间、反流次数、无效吞咽高于Nissen组和Dor组,差异均有统计学意义(P 0.05),但Nissen组和Dor组比较,差异无统计学意义(P0.05),3组术后1年LES静息压最小值、24 h pH阻抗监测、DeMeester评分、GERD-Q症状评分和GERD-HROL量表评分比较,差异均无统计学意义(P0.05);3组患者术后并发症发生率、手术无效率及复发率比较,差异均无统计学意义(P0.05)。结论腹腔镜食管裂孔疝修补术联合3种胃底折叠术治疗HH合并GERD均可起到抗反流的效果,但Nissen和Dor手术在改善LES静息呼吸压力值、反流和无效吞咽方面的效果优于Toupet手术。     

Technical considerations for laparoscopic transabdominal preperitoneal repair of concurrent Spigelian-inguinal hernia complex: A case report and review of literature

Spigelian hernia with concurrent inguinal hernia is not uncommon. The hernia location makes conventional laparoscopic repair challenging and this is commonly repaired by the open method. We present the technical considerations and feasibility, as well as literature review, of such a hernia repaired via a minimally invasive fashion. We performed a laparoscopic transabdominal preperitoneal hernia repair for a 59-year-old woman who presented with symptomatic irreducible large Spigelian-inguinal complex hernia, with a hernia neck of 4 cm on computed tomography scan. The hernia contents were reduced transabdominally and subsequently, the preperitoneal space was created via a transabdominal preperitoneal method to allow for hernia defect closure and subsequent mesh placement. The patient was discharged on postoperative day 2 without complication. At 6 months follow-up, she had no complications or recurrence. With increased experience, the laparoscopic repair of complex Spigelian-inguinal concurrent hernias is safe and feasible.     

Laparoscopic distal gastrectomy in a patient with gastric cancer complicated by eventration of the diaphragm: A case report

Diaphragmatic eventration refers to an abnormal elevation of the diaphragm. Here, we report the case of a patient with gastric cancer who underwent successful laparoscopic distal gastrectomy despite the presence of diaphragmatic eventration. The patient was a 72-year-old man diagnosed with early gastric cancer in the antrum, as detected by upper gastrointestinal endoscopy. Preoperative imaging revealed an elevation of the left side of the diaphragm, which was diagnosed as diaphragmatic eventration. Laparoscopic surgery is beneficial for obtaining an optimal field of view. However, there are critical points that must be considered when laparoscopic distal gastrectomy is performed in patients with gastric cancer complicated by diaphragmatic eventration. There were difficulties that affected manipulation because the elevated diaphragm drew the intraperitoneal organs into the thoracic cavity, causing displacement of the normal anatomical position. We found it beneficial to secure the lesser curvature of the stomach given the possible effects of gastric deformation.     

Case of giant paraesophageal hiatal hernia associated with Morgagni hernia

Simultaneous paraesophageal and Morgagni hernias are very rare. Here, we report a case involving a 91‐year‐old woman with simultaneous paraesophageal and Morgagni hernias. Both hernias were repaired laparoscopically. The postoperative course was uneventful. Laparoscopic repair for hernias seems to be feasible and minimally invasive, but only a few reports have described such repairs of hernial orifices.     

Laparoscopic sentinel node navigation surgery for early gastric cancer

The sentinel node (SN) concept has revolutionized how the surgical staging of both melanoma and breast cancer are approached. Applying this concept can yield benefits for the patient by avoiding various complications relating to unnecessary prophylactic regional lymph node dissection in cases with negative SN for cancer metastasis. Clinical application of SN mapping for early gastric cancer had been controversial for years. However, single institutional results of laparoscopic SN mapping for early gastric cancer are considered acceptable in terms of detection rate and accuracy in determining lymph node status. For early stage gastric cancer such as cT1N0M0 – in which a better prognosis was generally achieved through conventional surgical approaches – an individualized, minimally invasive surgery that might retain the patient's quality of life should be established as the next surgical challenge. Although there are many issues still to resolve, laparoscopic minimized gastrectomy with SN navigation surgery or combined endoscopic mucosal resection and endoscopic submucosal dissection has the potential to achieve this goal.     

Gasless laparoscopic and minilaparotomy Billroth I gastrectomy with hepatectomy for advanced gastric cancer with liver metastasis : Technique and case report

Summary

In advanced gastric cancer with solitary liver metastasis, minilaparotomy Billroth I gastrectomy and metastasectomy with laparoscopy was performed by gasless surgery. The patient was a 53-year-old female. Gastroscopic examination revealed gastric cancer (Borrman 3 type) in the antrum, and computed tomography showed a solitary liver metastasis located in segment III. On post-operative day 1, the patient was able to walk. On postoperative day 4 she was started on a clear liquid diet, and was discharged on post-operative day 14. During her post-operative recovery, the patient experienced very little pain. She did not request narcotic analgesia post-operatively.     

Laparoscopic-assisted thoracoscopic repair of latent traumatic diaphragmatic hernia: A case report

Surgical approaches for traumatic diaphragmatic hernia include transabdominal, transthoracic, and thoracoabdominal. Selection of the optimal approach depends on the timing and organ damage, often minimally invasive approaches with laparoscopy or thoracoscopy are performed. A 47-year-old man with blunt chest trauma was diagnosed with left traumatic diaphragmatic hernia 1 month after the trauma. The prolapsed omentum was detached from the chest wall and around the hernia orifice and returned to the abdominal cavity by coordinated thoracoscopic and laparoscopic manipulations. The 4 × 2 cm herniation in the diaphragm was sutured closed from the thoracic side while preventing re-prolapse of the omentum and abdominal organs from the abdominal side. A combined thoracoscopic and laparoscopic approach can be effective in confirming organ damage, repositioning of prolapsed organs, and safe repair of the diaphragm in latent traumatic diaphragmatic hernia.     

腹腔镜胃癌根治术治疗早期胃癌的临床疗效观察

目的探讨腹腔镜胃癌根治术治疗早期胃癌的临床疗效及临床应用价值。方法将58例早期胃癌患者随机分为2组,每组29例。治疗组患者接受腹腔镜胃癌根治术治疗,对照组患者采用传统的开腹胃癌根治术,将2组患者治疗前后的临床以及手术资料进行比较。结果与对照组相比,治疗组患者的手术时间、术中出血量、术后平均住院时间、术后进食流质时间、术后肠道功能恢复时间和术后并发症发生均率显著减少或降低,但2组肿瘤切缘和淋巴结清除数目无统计学差异。结论腹腔镜根治术治疗胃癌具有出血少、康复快、手术安全、微创等优点,值得临床推广应用。     

Esophagogastric junction cancer successfully treated by laparoscopic proximal gastrectomy and lower esophagectomy with intrathoracic double‐flap technique: A case report

A 66‐year‐old man was referred to our hospital for treatment of esophagogastric junction cancer. He was diagnosed as cT2N0M0, and the esophageal invasion was found to be 1 cm from the esophagogastric junction. He underwent laparoscopy‐assisted proximal gastrectomy and lower esophagectomy with esophagogastrostomy using the intrathoracic double‐flap technique through the transhiatal approach. The operative time was 662 min (suturing time was 198 min), and blood loss was 200 mL. The operative time was much longer for this procedure than for esophagogastrostomy with the conventional (intra‐abdominal) double‐flap technique. The postoperative course was uneventful. No abnormal gastroesophageal reflux, esophageal motility, or lower esophageal sphincter (LES) pressure was demonstrated 3 months after the operation. Laparoscopic proximal gastrectomy and lower esophagectomy with esophagogastrostomy using the double‐flap technique through the transhiatal approach is safe and feasible. It may be recommended for patients with esophagogastric junction cancer with esophageal invasion of about 1 cm.     

A case of Spigelian hernia after laparoscopic incisional hernia repair

Laparoscopic ventral hernia repair with intraperitoneal onlay mesh reinforcement is often performed in clinical practice. We herein describe a patient who developed a Spigelian hernia at the edge of the mesh due to rupture of the muscular layer in the abdominal wall. A 69-year-old woman developed a left-sided abdominal bulge 15 months after laparoscopic ventral hernia repair. CT showed a 33-mm defect in the abdominal wall at the lateral edge of the left abdominal rectus muscle with an intestinal prolapse through the defect. She was diagnosed with a Spigelian hernia and underwent operation. The hernia orifice was located at the aponeurosis of the transverse abdominal muscle where the thread had been used to fix the mesh through all layers of the abdominal wall. This report details a case of a Spigelian hernia after laparoscopic ventral hernia repair.