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Malone Appendicostomy (Antegrade) or Enemas (Retrograde) For Colonic Cleaning
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
Another option for the umbilical anastomosis in a Malone appendicostomy is a Y–V anastomosis that creates a triangular flap that covers the opening, allowing the umbilicus to appear more natural. This is the preferable technique during a laparoscopic Malone, as the umbilical fascia can be incised and the cecum delivered extracorporeally to perform the plication, but no infraumbilical skin incision is needed.
Anatomy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Ernest F. Talarico, Jalid Sehouli, Giuseppe Del Priore, Werner Lichtenegger
The paravesical space is limited medially by the obliterated umbilical artery (umbilical ligament), vesical fascia, and the ligament of the bladder. At its lateral margin, it merges into the retropubic space. The body of the corpus intrapelvinum and the cardinal ligament form the posterior boundary. The roof of the paravesical and prevesical space is formed by the vesico-umbilical fascia.
Infantile hypertrophic pyloric stenosis
Published in Prem Puri, Newborn Surgery, 2017
Prem Puri, Balazs Kutasy, Ganapathy Lakshmanadass
Since 1991,149 when the first laparoscopic pyloromyotomy was reported, there have been numerous publications supporting this approach,140,150 and recently, single incision laparoscopic pyloromyotomy also has been reported.151 For the laparoscopic procedure, the patient is placed in the supine position at the end of the table. A 5 mm port is placed in the umbilical fold after an open technique under direct vision. Pneumoperitoneum is established with CO2 at maximum pressure of 6–8 mmHg. Two additional access sites are placed in the left and right midclavicular line just below the costal margin under direct vision with the camera. The duodenum is grasped with atraumatic forceps just distal to the pylorus olive and stabilizes it. Endotome or diathermy hook is placed through the right incision, and the pylorus is incised in its avascular plane from the prepyloric vein well into the gastric antrum (Figure 52.8). The muscular layer is then separated with an endoscopic spreader (Figure 52.9). A satisfactory pyloromyotomy is evidenced by ballooning of the intact mucosa. The absence of mucosal perforation is checked by insufflations of air in the nasogastric tube; if none is seen, the instruments and ports are removed. The umbilical fascia is closed with 4-0 absorbable suture, and the skin of all the wound is reapproximated with 5-0 subcuticular absorbable sutures.34
Surgical Determinants of Post Operative Pain in Patients Undergoing Laparoscopic Adnexectomy
Published in Journal of Investigative Surgery, 2022
Lea Ebanga, Yohann Dabi, Jeremie Benichou, Gregoire Miailhe, Kamila Kolanska, Jennifer Uzan, Clement Ferrier, Sofiane Bendifallah, Bassam Haddad, Emile Darai, Cyril Touboul
Adnexal surgery is usually considered as a short and minor surgery mostly performed ambulatory. Laparoscopy is now considered the approach of choice for adnexal surgery. This is especially true as the large majority of adnexal masses have benign histology (ovarian cancer represents only the 0.4% of all adnexal masses [22]. However, in the case of an adnexal mass, the risk of intra-operative rupture increases with the size of the mass; Adnexal mass > 10 cm would thus be associated with a 50% risk of intra-operative spillage, which seems to be linked to the intrinsic limitations of the technique [23]. In this setting, the majority of patients will not experience intense postoperative pain. This is in line with data of the literature which considered adnexectomy as minor surgery not at risk of opioid consumption [6]. Two factors were clearly associated with the risk of requiring an opioid postoperatively: fascia closure and duration of pneumoperitoneum. Another factor that could definitely have an impact on postoperative pain was the history of surgery. Indeed, we could hypothesize that the way a patient respond to pain in the postoperative period could be influenced by his past experience of pain and his personal history. In our cohort, the history of surgery had no impact on the amount of postoperative pain, which is consistent with our finding of the absence of influence of adhesiolysis during surgery. Fascia closure is currently recommended in port > 10 mm since the risk of port site hernia is significant (up to 20% in some series) [24,25]. While cases of port site hernia have been reported in patients with 5 mm port, their incidence remain rare (less than 1%) and fascia closure in such port is at surgeon’s discretion [26,27]. The use of Veress needle for first insufflation and development of mini laparoscopy using only < 5 mm ports could reduce the need for fascia closure and thus, postoperative pain. Boza et al. [28] have shown in a 110 patients’ cohort mini laparoscopic gynecologic surgery using 3-mm trocars resulted in decreased postoperative incisional pain as well as superior cosmetic appearance. In our cohort, the use of 3 mm port was not associated with reduced postoperative pain. One explanation is that adnexectomy is a short surgery and the benefit not large enough to be shown on our cohort. Furthermore, in patients with large adnexal masses, secondary widening of the umbilical fascia to extract the adnexa was required which could have balanced the benefit of performing micro laparoscopy. In our cohort, around half of micro – laparoscopic patients had umbilical fascia stitch impairing the benefit of this surgical approach. Moreover, in our cohort, no patient had direct optical access. This bladeless approach could be interesting to limit postoperative pain and should be studied in further studies. To avoid enlarging the ancillary trocar port, the transvaginal extraction by culdotomy of the surgical specimen could be an option in some patients. It could limit the weakening of the abdominal wall that is associated with increased morbidity.