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Carmen BALAGUÉ PONZ

Hospital de la Santa Creu i Pau
Barcelona, Spain
MD, PhD
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14763 views
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Laparoscopic enucleation of horseshoe-shaped esophageal leiomyoma: use of mini-instruments
Introduction:
Leiomyoma is the most common benign tumor of the esophagus, usually arising in the inner circular muscle layer of the distal esophagus. Middle-aged men are most frequently affected. Most patients remain asymptomatic and when they become symptomatic, the main signs are usually dysphagia and epigastric pain, but they are not specific to the disease. Malignization is rare but should not be ignored.
The minimally invasive approach to these tumors allows for complete extirpation with minimal morbidity and provides excellent results.

Materials and methods:
We present the case of a 31-year-old woman with no medical history, who underwent a CT-scan for other reasons, namely for urinary symptoms. A 3cm homogeneous, low attenuated mass was found at the gastroesophageal junction. Endoscopic ultrasound is performed and showed a 50mm horseshoe-shaped tumor affecting three quarters of the esophageal circumference. Because of clinical deterioration, and mainly of dysphagia, elective surgery was decided upon.

Results:
In this video, it is possible to appreciate the laparoscopic enucleation of this horseshoe-shaped tumor, which depends on the distal esophageal wall, mainly using blunt dissection. The intervention is completed with a Toupet fundoplication. The postoperative course was uneventful, and the patient is discharged on the third postoperative day, and symptoms are resolved.

Conclusions:
Minimally invasive laparoscopic resection of distal esophageal benign tumors is technically safe and provides the well-known advantages of laparoscopic access, achieving quick patient recovery and a short hospital stay.
Some authors recommend to perform an anti-reflux procedure in order to protect the surgical resection area and therefore prevent complications due to the weakening of the lower esophageal sphincter, such as reflux symptoms.
C Rodríguez-Otero Luppi, EM Targarona Soler, C Balagué Ponz, JL Pallarés Segura, M Trías Folch
Surgical intervention
5 years ago
769 views
4 likes
1 comment
08:45
Laparoscopic enucleation of horseshoe-shaped esophageal leiomyoma: use of mini-instruments
Introduction:
Leiomyoma is the most common benign tumor of the esophagus, usually arising in the inner circular muscle layer of the distal esophagus. Middle-aged men are most frequently affected. Most patients remain asymptomatic and when they become symptomatic, the main signs are usually dysphagia and epigastric pain, but they are not specific to the disease. Malignization is rare but should not be ignored.
The minimally invasive approach to these tumors allows for complete extirpation with minimal morbidity and provides excellent results.

Materials and methods:
We present the case of a 31-year-old woman with no medical history, who underwent a CT-scan for other reasons, namely for urinary symptoms. A 3cm homogeneous, low attenuated mass was found at the gastroesophageal junction. Endoscopic ultrasound is performed and showed a 50mm horseshoe-shaped tumor affecting three quarters of the esophageal circumference. Because of clinical deterioration, and mainly of dysphagia, elective surgery was decided upon.

Results:
In this video, it is possible to appreciate the laparoscopic enucleation of this horseshoe-shaped tumor, which depends on the distal esophageal wall, mainly using blunt dissection. The intervention is completed with a Toupet fundoplication. The postoperative course was uneventful, and the patient is discharged on the third postoperative day, and symptoms are resolved.

Conclusions:
Minimally invasive laparoscopic resection of distal esophageal benign tumors is technically safe and provides the well-known advantages of laparoscopic access, achieving quick patient recovery and a short hospital stay.
Some authors recommend to perform an anti-reflux procedure in order to protect the surgical resection area and therefore prevent complications due to the weakening of the lower esophageal sphincter, such as reflux symptoms.
Laparoscopic splenectomy in a patient with cirrhosis and splenomegaly
Introduction
The first laparoscopic splenectomy was initially described more than 20 years ago. Hypersplenism associated with thrombocytopenia in cirrhotic patients could compromise quality of life and also limit therapeutic options such as interferon treatment.
Material and methods
We present the case of a 48-year-old woman with a history of parenteral drug abuse, HCV/HIV co-infection, cirrhosis (Child-Pugh B). Treatment with interferon and antiretrovirals must be discontinued for severe thrombocytopenia. As a result, laparoscopic splenectomy stands out as a therapeutic measure.
Results
In this video, we present a laparoscopic splenectomy approach in a cirrhotic patient with splenomegaly and hypersplenism in order to initiate interferon and antiretroviral treatment. It is possible to note the presence of collateral circulation, cirrhotic liver, and moderate splenomegaly (final spleen weight of 735 grams).
Conclusions
Laparoscopic access proves safe and effective in cirrhotic patients in order to extend the therapeutic managements of their underlying diseases. It can also improve the Child-Pugh score.
C Rodríguez-Otero Luppi, EM Targarona Soler, C Balagué Ponz, JL Pallarés Segura, M Trías Folch
Surgical intervention
5 years ago
6886 views
129 likes
0 comments
08:01
Laparoscopic splenectomy in a patient with cirrhosis and splenomegaly
Introduction
The first laparoscopic splenectomy was initially described more than 20 years ago. Hypersplenism associated with thrombocytopenia in cirrhotic patients could compromise quality of life and also limit therapeutic options such as interferon treatment.
Material and methods
We present the case of a 48-year-old woman with a history of parenteral drug abuse, HCV/HIV co-infection, cirrhosis (Child-Pugh B). Treatment with interferon and antiretrovirals must be discontinued for severe thrombocytopenia. As a result, laparoscopic splenectomy stands out as a therapeutic measure.
Results
In this video, we present a laparoscopic splenectomy approach in a cirrhotic patient with splenomegaly and hypersplenism in order to initiate interferon and antiretroviral treatment. It is possible to note the presence of collateral circulation, cirrhotic liver, and moderate splenomegaly (final spleen weight of 735 grams).
Conclusions
Laparoscopic access proves safe and effective in cirrhotic patients in order to extend the therapeutic managements of their underlying diseases. It can also improve the Child-Pugh score.
Laparoscopic excision of a large leiomyoma of the esophagogastric junction
Esophageal leiomyomas represent a benign pathology that usually affects the distal third and the esophagogastric junction, and that is perfectly suitable for a laparoscopic enucleation. A correct preoperative diagnosis is mandatory, as the most common differential diagnosis in this localization is represented by gastrointestinal stromal tumors (GIST), a pathology that could benefit from neo-adjuvant therapy. Occasionally, leiomyomas can be adherent to the mucosal layer, in which case-limited mucosal excision is necessary.
We present a laparoscopic enucleation of a large leiomyoma of the esophagogastric junction, requiring the use of an endostapler for complete resection.
C Balagué Ponz, EM Targarona Soler, S Mocanu, S Fernandez Ananin, F Marinello, M Trías Folch
Surgical intervention
6 years ago
1478 views
7 likes
0 comments
09:00
Laparoscopic excision of a large leiomyoma of the esophagogastric junction
Esophageal leiomyomas represent a benign pathology that usually affects the distal third and the esophagogastric junction, and that is perfectly suitable for a laparoscopic enucleation. A correct preoperative diagnosis is mandatory, as the most common differential diagnosis in this localization is represented by gastrointestinal stromal tumors (GIST), a pathology that could benefit from neo-adjuvant therapy. Occasionally, leiomyomas can be adherent to the mucosal layer, in which case-limited mucosal excision is necessary.
We present a laparoscopic enucleation of a large leiomyoma of the esophagogastric junction, requiring the use of an endostapler for complete resection.