Laparoscopic versus open resection for appendix carcinoid

Background Since an increasing number of appendectomies are performed via laparoscopy, it is crucial to determine the impact of this approach on appendix carcinoid (AC) outcome. The goal of this study was to compare results of laparoscopic (LAP) versus open (OP) appendectomy for AC according to intend to treat approach. Methods A retrospective review (1991–2003) identified 39 patients (median age, 36 years; range, 12–83) treated by laparoscopy (LAP) or laparotomy (OP) for AC in a single institution. Follow-up was complete for all patients (median, 67 months; range, 4–132). Results Most cases had associated acute appendicitis (64%). Median carcinoid size was 1.1 cm (range, 0.3–5) and 0.4 cm (range, 0.2–3) in the LAP and OP groups, respectively. LAP and OP were performed in 21 (54%) and 18 (46%) patients, respectively. Surgical margins were positive in two patients in the LAP group and one patient in the OP group (p = 0.6). Right colectomies were performed for AC >2 cm in five patients after LAP and in four patients after OP (p = 0.9). Actuarial 5-year survival rates were 100 and 94% in the LAP and OP groups, respectively (p = 0.2). Two patients died in the OP group, one due to metastatic carcinoid and the other due to metachronous colorectal cancer. Synchronous or metachronous colorectal carcinomas developed in six patients (15%). Conclusion Laparoscopic appendectomy is a safe procedure for AC, with carcinologic and long-term results similar to those of conventional appendectomy. Thus, pre- or per-operative suspicion of AC is not a contraindication to LAP. Prognosis of AC appears more dependent on carcinoid malignant potential or associated tumors. Risk for developing colorectal adenocarcinoma is high in AC patients and warrants follow-up of all patients with colonoscopic screening.     

Laparoscopic resection of mucinous cystadenoma of appendix: a careful decision

Appendiceal mucoceles are mainly due to cystadenoma or cystadenocarcinoma. Definite diagnosis is difficult preoperatively and is usually peroperatively. Surgical excision, either by laparoscopy or by laparotomy, is the mainstay of treatment. Rupture of the lesion causes pseudomyxoma peritonei. We present a case to highlight this point and especially deplore the use of laparoscopy if the tumor clearly extends beyond the appendix.     

Torquated giant appendix epiploica mimicking intraperitoneal liposarcoma: report of a case

A 49-year-old woman presented with acute abdominal pain in the right iliac fossa in our emergency department. Pain was abrupt in onset and severely colicky in nature. Abnormal laboratory values included a C-reactive protein of 75 mg/L and a CA-125 of 70.3 U/mL. White blood cell count was normal. Abdominal computed tomography (CT) scan revealed an inhomogeneous mass of 9.5 x 3.5 x 5.5 cm in diameter close to the appendix vermiformis and the sigmoid colon. Because of the clinical symptoms of an acute abdomen an explorative laparotomy was performed. Intraoperatively a pedunculated tumor beginning at the serosa of the sigmoid colon was found. The appendix was unremarkable. The macroscopic aspect as well as the backtable incision of the tumor was suspicious of an intraperitoneal liposarcoma. Rapid section and histopathologic examination revealed necrotic fat tissue without any malignancy. The patient was discharged from the hospital 7 days after the operation with normal laboratory parameters and without further complication. When epiploic appendagitis is evident as a big tumor mass in addition to clinical symptoms of an acute abdomen and elevated tumor markers, surgical exploration is mandatory.     

Laparoscopic removal of a rudimentary uterine horn in a previously hysterectomized patient.

BACKGROUND: The unicornuate uterine anomaly is often difficult to diagnose and usually low on the list of differential diagnoses for pelvic pain and dysmenorrhea. The authors present a case of a rudimentary uterine horn as a cause for continued pelvic pain and dysmenorrhea in a previously hysterectomized woman. CASE REPORT: A 43-year-old woman, gravida 1, para 1, presented for evaluation of right lower quadrant pain of several years' duration. Her past surgical history was significant for multiple prior laparoscopies and a vaginal hysterectomy. Radiographic studies revealed a mass in the right lower quadrant. Laparoscopy revealed a solid mass in the right pelvis that was diagnosed as a rudimentary uterine horn. CONCLUSION: Uterine anomalies, although uncommon, should be thought of as part of the differential diagnosis for pelvic pain and dysmenorrhea. A thorough inspection of the pelvis should be performed at the time of any operative procedure for abdominal pain.     

Laparoscopic management of a torted appendix

Torted appendices are a rare occurrence but should be considered when encountering a haemorrhagic congested appendix on laparoscopy. As adhesions are rarely present, laparoscopic excision is usually a feasible option.     

Strangulated appendix epiploica in paraumbilical hernia: preoperative diagnosis and laparoscopic treatment

Appendix epiploica can occasionally cause acute abdominal pain. The usual presentations are torsion or primary epiploic appendicitis. Strangulation inside a paraumbilical hernia with acute abdominal pain is seldom reported in the literature. The authors report a case of preoperative diagnosis and laparoscopic treatment of strangulated appendix epiploica in paraumbilical hernia that presented as acute abdominal pain.     

Laparoscopic liver resection for hemorrhagic hepatocellular adenoma in a pregnant patient

Introduction: Hepatocellular adenoma (HCA) is a benign neoplasm of the liver, however, with a potential for life-threatening hemorrhage. The unpredictable course during pregnancy poses a clinical dilemma in the pregnant patient. Intra-peritoneal rupture may lead to life-threatening situations with adverse outcome for mother and unborn child. A pre-emptive strategy with adequate treatment before pregnancy is strongly advised. However, the strategy for treating symptomatic HCA during pregnancy remains challenging as experience is limited.

Case presentation: A 31-year-old pregnant patient at the gestational age of 17 weeks presented with an acute episode of right upper abdomen pain. MR-imaging revealed a lesion of 9?cm located in segment III with stigmata of recent hemorrhage. At 18 weeks of gestation, she underwent a semi-elective laparoscopic left lateral sectionectomy.

Results: Surgery and postoperative recovery were uneventful. Patient was discharged at POD +6. At 40 weeks of gestation, she went in spontaneous labor and delivered a healthy baby. Histological examination confirmed a HCA, inflammatory subtype, showing features of hemorrhage.

Conclusion: In the pregnant patient, HCA represents a significant diagnostic and therapeutic challenge. Anatomically favorable located lesions can be safely managed with laparoscopic liver resection. We suggest that laparoscopic liver resection should be considered as part of the currently available strategies for HCA during pregnancy.     

Laparoscopic resection of small bowel gastrointestinal stromal tumour in a patient with neurofibromatosis

Gastrointestinal stromal tumour has been reported to be associated with neurofibromatosis. We report here a patient with neurofibromatosis who presented with gastrointestinal bleeding of obscure origin. The small bowel tumour that was revealed by enteroclysis was successfully resected laparoscopically.     

Laparoscopic abdominoperineal resection for rectal cancer in a patient with situs inversus totalis

Situs inversus totalis (SIT) is a very rare condition. Laparoscopic surgery in a patient with SIT is difficult because the surgeon's dexterity is compromised during the procedure, and the patient's anatomy is the mirror image of normal. We present a SIT patient who underwent laparoscopic abdominoperineal resection for rectal cancer. The detailed operative procedures and trocar placement considerations are described.     

Horseshoe anomaly of the appendix: a previously undescribed entity

Anomalies of the appendix are extremely rare. The case presented here has not been previously described and is that of a "horseshoe" appendix in a 33-year-old man with sigmoid diverticulitis. This appendiceal variant cannot be classified into any of the existing categories of appendiceal anomalies.     

Laparoscopic cecal cancer resection in a patient with a ventriculoperitoneal shunt: A case report

INTRODUCTIONThe presence of a ventriculoperitoneal shunt has been considered to be a contraindication for laparoscopic surgery till date; however, laparoscopic cholecystectomy was recently reported as safe for patients with this shunt.PRESENTATION OF CASEWe present the first case, to the best of our knowledge, of laparoscopic colectomy for cecal cancer in a patient with a ventriculoperitoneal shunt. A 59-year-old woman with a ventriculoperitoneal shunt for hydrocephalus was referred to our hospital with cecal cancer. Laparoscopic cecal cancer resection was performed successfully and uneventfully by manipulating the shunt.DISCUSSIONClamping of the shunt catheter at the subcutaneous region was performed before insufflation of carbon dioxide to prevent adverse effects from the pneumoperitoneum.CONCLUSIONWe believe that laparoscopic colectomy for colon cancer can be performed safely in patients with a ventriculoperitoneal shunt by optimal manipulation of the shunt.     

Laparoscopic resection of perforated Meckel's diverticulum in a patient with clinical symptoms of acute appendicitis

We report the laparoscopic resection of a perforated Meckel's diverticulum (MD) found in a 14-year-old boy who presented with abdominal pain and nausea. There was rebound tenderness in the right lower quadrant of the abdomen, which appeared suspicious for acute appendicitis. The patient was referred to the operating room, and laparoscopic appendectomy was performed. With the appendix showing no macroscopic signs of inflammation, laparoscopy was continued and a perforated MD was identified 50 cm proximal to the ileocecal valve. The findings included pus and localized peritonitis between the ileal loops adjacent to the perforation site. The diverticulum was longitudinally resected with an Endo-Gia stapler. The histopathologic workup confirmed the diagnosis of a perforated MD. The patient completely recovered and was discharged 8 days after the procedures. At this writing, he is completely asymptomatic 6 months later. We conclude from our observation that laparoscopic resection of a perforated MD can be performed safely even when localized peritonitis is present. Inspection of the small intestine should be performed to exclude a symptomatic or perforated MD when the appendix does not show any signs of acute appendicitis.     

Laparoscopic resection of periadrenal paraganglioma in a patient with multiple endocrine neoplasia type 2A

We report here a case of recurrent pheochromocytoma successfully managed by laparoscopic surgery in a patient with multiple endocrine neoplasia type 2A. A 25-year-old man presented with the contralateral adrenal mass after earlier right adrenalectomy. For the preoperative diagnosis of left adrenal pheochromocytoma, adrenal sparing surgery was considered. From the intraoperative laparoscopic view, we found that the tumor originated in periadrenal sympathetic ganglia, and laparoscopic excision of paraganglioma was successfully performed that preserved the integrity of normal adrenal gland. Extra-adrenal pheochromocytoma is rather rare in MEN 2A and it is important to identify precise intraoperative localization of pheochromocytoma with laparoscopic surgery.