Mario Knežević

Complications in laparoscopic and open colorectal resections: a single surgeon experience

Cutaneous abdominal metastasis from a primary lung tumour conveys a poor prognosis. Abdominal wall reconstruction following tumour resection usually involves construction of a myocutaneous flap, creating significant risk of hernia formation and increasing morbidity in the palliative patient. In the presented patient, loss of cutaneous continuity due to metastatic tumour and subsequent radiotherapy resulted in a contaminated operating field. As an alternative to a myocutaneous flap, a biological mesh was laparoscopically placed deep to the abdominal wall resection defect, providing reinforcement and reducing the risk of prosthesis infection. Split skin grafting from a right thigh donor site was then performed. To our knowledge, this is the first reported laparoscopic mesh placement for the prevention of ventral hernia formation following abdominal wall lung cancer metastasis resection. It provides a quick, low morbidity alternative to more extensive abdominal wall reconstruction enabling faster discharge from hospital. P002 – Abdominal Cavity and Abdominal WallAim: Laparoscopic splenectomy presents a challenge in patients with splenomegaly despite being the preferred procedure for most elective splenectomies. Our experience with laparoscopic splenectomy in the setting of splenomegaly is presented. Methods: The data were collected prospectively from May 2003. to October 2011. in 39 patients that underwent LS in Clinical Hospital “Dubrava” Zagreb, Croatia. The nature of disease, spleen size (measured on CT or ultrasound), gender, age, op time, conversion, hospital stay, need for accessory incision, type of splenic artery ligation preoperative and postoperative platelet values were recorded. The impact of diagnosis (benign/malignant) and the spleen size onto the outcome following LS in seven years period were evaluated. Results: Majority of patients submitted to LS had benign hematologic disease (30 of 39) and more than half of them had splenomegaly (23/39). Majority of patients with splenic malignancy have splenomegaly (8 of 9). The mean spleen size in splenomegaly patients was 23, 88 cm (range 15-31 cm). Splenomegaly was associated with higher conversion rate (3 vs 2) due to bleeding and longer mean operative time (128, 54 vs 104, 75 min). Furthermore, in splenomegaly more patients required accessory incision and additional port (7 vs 1) and blood transfusion (8 vs 1). But length of stay and postoperative morbidity was not associated with enlarged spleen in our series. Conclusion: According to our results, the same as to some previously presented studies LS has become a treatment of choice for majority of patients including those with splenomegaly. In spite of longer operative time and more blood loss laparoscopic splenectomy in the setting of splenomegaly is safe in appropriately experienced hands with full awareness of increased complexity of technical performance and caution requirement.

Laparoscopic splenectomy in patients with splenomegaly-tendency or contraindication?

Cutaneous abdominal metastasis from a primary lung tumour conveys a poor prognosis. Abdominal wall reconstruction following tumour resection usually involves construction of a myocutaneous flap, creating significant risk of hernia formation and increasing morbidity in the palliative patient. In the presented patient, loss of cutaneous continuity due to metastatic tumour and subsequent radiotherapy resulted in a contaminated operating field. As an alternative to a myocutaneous flap, a biological mesh was laparoscopically placed deep to the abdominal wall resection defect, providing reinforcement and reducing the risk of prosthesis infection. Split skin grafting from a right thigh donor site was then performed. To our knowledge, this is the first reported laparoscopic mesh placement for the prevention of ventral hernia formation following abdominal wall lung cancer metastasis resection. It provides a quick, low morbidity alternative to more extensive abdominal wall reconstruction enabling faster discharge from hospital. P002 – Abdominal Cavity and Abdominal WallAim: Laparoscopic splenectomy presents a challenge in patients with splenomegaly despite being the preferred procedure for most elective splenectomies. Our experience with laparoscopic splenectomy in the setting of splenomegaly is presented. Methods: The data were collected prospectively from May 2003. to October 2011. in 39 patients that underwent LS in Clinical Hospital “Dubrava” Zagreb, Croatia. The nature of disease, spleen size (measured on CT or ultrasound), gender, age, op time, conversion, hospital stay, need for accessory incision, type of splenic artery ligation preoperative and postoperative platelet values were recorded. The impact of diagnosis (benign/malignant) and the spleen size onto the outcome following LS in seven years period were evaluated. Results: Majority of patients submitted to LS had benign hematologic disease (30 of 39) and more than half of them had splenomegaly (23/39). Majority of patients with splenic malignancy have splenomegaly (8 of 9). The mean spleen size in splenomegaly patients was 23, 88 cm (range 15-31 cm). Splenomegaly was associated with higher conversion rate (3 vs 2) due to bleeding and longer mean operative time (128, 54 vs 104, 75 min). Furthermore, in splenomegaly more patients required accessory incision and additional port (7 vs 1) and blood transfusion (8 vs 1). But length of stay and postoperative morbidity was not associated with enlarged spleen in our series. Conclusion: According to our results, the same as to some previously presented studies LS has become a treatment of choice for majority of patients including those with splenomegaly. In spite of longer operative time and more blood loss laparoscopic splenectomy in the setting of splenomegaly is safe in appropriately experienced hands with full awareness of increased complexity of technical performance and caution requirement.