Monthly publications

Reversal of Hartmann's procedure is a major undertaking and due to its associated morbidity and mortality, many patients are left with permanent colostomy and many others elect not to have the reversal. The advances in laparoscopy and stapler anastomosis have made the reversal simpler and easier. The objective of this film is to show how to carry out a laparoscopic re-intervention of a stenosis of a colorectal anastomosis performed some months before for the restoration of the colorectal continuity after a laparoscopic reversal of Hartmann’s procedure that was performed to manage a perforated sigmoid diverticulitis.

In this video, we show the case of a 70-year-old male patient who had several attacks during the last weeks, abdominal pain, and fever. After CT-scan, he was diagnosed a perisigmoid abscess. We diagnosed a lot of diverticula and we made a diagnosis of sigmoiditis with perisigmoid abscess. So this is the Hinchey II two pelvic abscess. We began the medical treatment and finally we had several attacks and did a new examination, a new CT-scan, and an endoscopy and not a sigmoid abscess, but a voluminous diverticulum with an abscess, was diagnosed. So it was decided to operate on the patient.

Laparoscopic sigmoid colectomy has become an acceptable method of surgical treatment for diverticulitis. However, during acute procedures, dissection is challenging. The objective of this film is to demonstrate the dissection performed during an acute sigmoid diverticulitis with attachment of the ureter at the level of the inflammation.

The objective of this film is to demonstrate how to perform a total colectomy by means of the new Ligasure Atlas Blunt Tip® vessel-sealing device, which allows for a perfect hemostasis and can be used for dissection like the finger of one’s hand.

This video demonstrates a redo laparoscopic Nissen fundoplication in a 34-year-old man with recurrent gastroesophageal reflux symptoms. A first laparoscopic Nissen-Rossetti procedure was performed ten years ago, and was taken down 2 months after surgery for severe dysphagia and important weight loss.
The success rate of laparoscopic Nissen fundoplication depends on the proper creation of a floppy and symmetric wrap together with a suitable crural repair. Most failures and complications due to technical mistakes during antireflux surgeries are related to an incomplete or inadequate intraoperative evaluation of the wrap and crural repair. Development or persistence of dysphagia after fundoplication is among the most common complications occurring in up to 30% of patients. Surgical factors responsible for de novo dysphagia are mainly related to the degree, tightness, length of the fundoplication and technical errors leading to wrap misconstruction -below the anatomical gastroesophageal junction or by a distortion of the esophageal diameter and orientation at the level of the crural repair.

The video "Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty" authored by M. Vix, F. Costantino and J. Marescaux is analysed by Dr. Kelvin Dwight Higa, MD, FACS, FASMBS, sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

This video shows a laparoscopic splenectomy in a young patient who developed several septic emboli originating from a skin wound. One of these septic emboli induced a splenic abscess. Due to vegetations on a cardiac aortic valve, cardiovascular surgeons ask to remove the spleen along with the intrasplenic abscess prior to envisaging an intervention on the valve.

Laparoscopic sleeve gastrectomy is a widely accepted bariatric procedure. In this lecture, Professor Jacques Himpens presents all the technical details when performing this procedure and shows the difference between the old and the new steps of greater curvature dissection.

In this lecture, Dr. Pantelis Trompoukis analyzes the global results of endometriosis and its impact on the population. The current effect of surgical treatment on deep infiltrating endometriosis is also reviewed, together with the outcomes. Finally, some first results of a retrospective study of 220 patients who were operated on for severe endometriosis in his department are presented.

Ιn this very didactic video, Dr. Anastasia Ussia gives an overview of the pathophysiology, provides definitions of endometriosis, and highlights the importance of having a good classification designed to give description and also to allow for the statistical validation and analysis of the disease.

Some believe that laparoscopy is almost impossible to perform in cases of very big uterus or large adnexal masses that obstruct our view to the pelvis. However, if the same surgical steps are always followed and a specific strategy is determined, it is feasible and safe to choose laparoscopy even in the case of large organs. In this video, we present the case of a 45-year-old patient with a large fibromatous uterus, suffering from abdominal discomfort and bleeding. The patient was anemic and decision was made to perform a laparoscopic total hysterectomy. With the appropriate surgical steps and some safety tips, the operation took place quickly and with success. The weight of the specimen was 1300g.

Surgery is the treatment of choice for myomas. Myomectomy has undergone a dramatic evolution over the years. Laparoscopic myomectomy provides a preferable alternative to abdominal myomectomy for women with symptomatic fibroids who desire uterine preservation. It is also an excellent method for women who have infertility primarily related to fibroids. A lot of patients prefer myomectomy over hysterectomy even if they do not desire pregnancy. However, laparoscopic myomectomy is not easy and needs some practice. Together with the basic steps, some tips and tricks are provided to make this technique even more safe and feasible for surgeons. For good results, the use of a few technical tricks provides an optimal solution for all issues.

The Endoscopic Retrograde Cholangio-Pancreatography (ERCP) has become the gold standard for the treatment of cholelithiasis with a success rate of 95%.
The dimensions of a giant biliary calculus are equal to or bigger than 2cm.
Various endoscopic tools such as the mechanical lithotripsy or extracorporeal shock wave lithotripsy (ESWL) have been described to treat this pathology. Surgery is offered to cases unresolved by endoscopic therapy.
Recently, the sphincteroplasty with a large-size balloon dilatation of the papilla has been described as an option for the endoscopic management of the giant biliary stone.
This is a case of extraction of giant common bile duct calculus using the combination of sphincterotomy and large-size balloon sphincteroplasty.

Duodenal diverticula are found in approximately 10-20% of patients undergoing Endoscopic Retrograde Cholangio-Pancreatography (ERCP).
Usually, these diverticula lie within 2cm of the major duodenal papilla and are called juxtapapillary diverticula. They are mostly acquired and their incidence increases with age.
Juxtapapillary diverticula have often been associated with mechanical compression and they are also involved in Oddi’s sphincter dysfunction. The presence of juxtapapillary diverticula is known to influence the outcome of ERCP procedure by making it more difficult and causing some complications like bleeding. Various techniques have been advised for a more successful ERCP outcome
In this video, four cases of duodenal diverticula are presented to provide tips and tricks for the successful cannulation of the CBD and management of periampullary bleeding in case they occur.

In this key lecture, Professor Swanström provides a complete update on NOTES and Single Port procedures taking into account surgeon and gastroenterologist experience.

In this lecture, Dr. Targarona shows the evolution from laparoscopic to NOTES and single port splenectomy. This lecture features video demonstrations of standard NOTES and SILS™ procedures. He discusses about these two new techniques showing benefits and contra indications.

In this interesting lecture, Professor Yoon Ah Park presents the application of the DaVinci robot system to colorectal laparoscopic surgery presenting the actual benefits and unsolved problems using the robot.