In our initial experience, SSRM is a safe and effective method of immediate implant-based breast reconstruction.
A 73-year-old lady presented with colicky central abdominal, anorexia, nausea and rigors. Physical examination revealed that she was afebrile, but had right upper quadrant tenderness, mildly deranged liver function and a white cell count of 25 ¥ 10 9 /L and a C reactive protein of 586 units. Abdominal ultrasound and computerised topography scanning findings were consistent with acute cholecystitis, (a large, thick walled gall bladder with pericholecystic fluid). She was initially treated with intravenous antibiotics and surgery was planned for the following morning.Laparoscopy revealed a gangrenous gall bladder with colon and omentum adherent to it. At laparotomy, an empyema was encountered and retrograde cholecystectomy was performed. An aberrant 4-mm diameter duct was found passing from the lateral aspect of the gall bladder fossa of the liver to the body of the gall bladder. This was divided, cholecystectomy was completed and cholangiography was performed via both the cystic and aberrant ducts (Figs 1,2).The cholangiogram revealed an aberrant duct passing from the cannulation site to join the right posterior segmental duct. As the aberrant duct was not draining a discrete segment of the liver it was able to be ligated. The cystic duct was also ligated. Post-operatively, the patient made an uneventful recovery with no bile leak.
Background Right-sided colon cancer is now commonly treated by laparoscopic right hemicolectomy (LRH). The best procedure for mesentery dissection and nodal harvesting is still being debated. The purpose of this research is to compare intra-corporeal mesentery dissection (ICMD) with extra-corporeal mesentery dissection (ECMD) approaches and assess their impact on nodal harvest during LRH. Methods A retrospective analysis of 78 operative cases of LRH was performed. The patients were divided into two groups: those with ICMD (n = 30) and those with ECMD (n = 48). The total number of lymph nodes extracted was the primary outcome. The number of positive lymph nodes, length of hospital stay, and surgical complications were some of the secondary objectives. Results The total number of lymph nodes extracted in the ICMD was considerably higher (p = 0.02). Cancers located in the ascending colon were associated with more lymph nodes than tumours located in the cecum or hepatic flexure (p0.001). The two groups did not differ significantly regarding the median number of positive lymph nodes or length of hospital stay. Conclusion This study demonstrates that ICMD provides improved nodal yield compared to ECMD in LRH for right-sided colon cancer. Tumor location also impacts the nodal yield, with tumors in the ascending colon having the highest yield. Understanding the optimal mesentery dissection technique and nodal harvest can help improve the oncological outcomes. The use of robotic surgical equipment may further enhance the ICMD approach, especially for accessing retroperitoneal structures.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.