Lipoma Excision Research Articles

LVAs in a Pedicled SIEA Flap for the Treatment of Recurrent Lymphocele of the Groin Using Superficial Veins of the Flap for Lymphovenous Anastomosis: A Case Report and Literature Review.

Persistent lymphocele of the groin is a complication of groin surgery that can severely impact the quality of life. The restoration of the interrupted lymphatic pathway is considered by many authors the ideal treatment to prevent a recurrence. However, multiple aspiration procedures and surgical revisions can compromise the availability of local veins needed for a lymphovenular bypass surgery. In addition, surgical debridement of a long-standing lymphocele can generate extensive dead space and contour deformity. A flap delivering additional venules for trans-flap lymphovenular anastomoses (LVAs) can overcome both problems by providing soft tissue and competent veins harvested outside the zone of injury. A successful case of severe groin lymphocele treated with trans-flap LVAs from an abdominal-based flap is presented. The patient was referred to us for a recurrent lymphocele developed in the right groin after lipoma excision that persisted despite multiple surgical attempts. After the identification of patent and draining inguinal lymphatic vessels, a pinch test was used to design a mini-abdominoplasty superficial inferior epigastric artery flap. The superficial veins of the cranial incision were identified and anastomosed to the lymphatic vessels after the pedicled flap harvested and insetted in the groin. The early restoration of lymphatic drainage and the optimal aesthetic outcome supports the combined approach offered by trans-flap LVAs as a valuable therapeutic option for severe and persistent lymphocele.

Assessment of Knowledge and Awareness Levels of Lipoma and Simple Surgical Excision Among Adults in Makkah Region, Saudi Arabia.

Background Lipoma is a soft tissue tumor primarily composed of fat cells. These slow-growing, painless, subcutaneous nodules can occur in any place in the body where fat is present. Our study aims to assess the awareness, knowledge, and attitudes of Makkah region inhabitants regarding lipomas and the surgical excision method. Methodology This study used a cross-sectional methodology to evaluate the general public's knowledge regarding lipomas and the surgical excision method using a self-administered questionnaire in the Makkah region from January to April 2024. Results A total of 367 participants were included, with the majority (56.10%) aged between 18 and 29 years. The survey revealed that 48.50% had heard about lipomas, 42.80% lacked any knowledge about them, and 26.70% acquired their information via social media. Furthermore, 31.60% believed it to affect both genders equally, 46.60% admitted uncertainty, 20.40% correctly identified that lipomas can occur at any age, and 39.80% were uncertain. Overall, 57.20% correctly identified lipomas as benign tumors composed of fat cells. Opinions diverged on whether lipomas cause pain, with 46.90% being uncertain. Moreover, 25.90% of respondents thought that surgery was the sole option for removing a lipoma, while 38.10% recognized the risk of lipoma recurrence after surgical removal. Overall, 85.60% reported never being diagnosed with a lipoma, while 4.10% had been diagnosed, predominantly with single lipomas 6.00%. There were significant differences in the participants' marital status, with widowed people exhibiting the greatest awareness level, followed by single people. Conclusions Our study findings indicate a moderate level of awareness about lipomas among residents of the Makkah region. However, there are significant gaps in understanding various aspects of lipomas, including their characteristics, treatment options, and demographic distribution.

Colonic intussusception from pedunculated colonic lipoma at hepatic flexure: A case report and review of current literature

Colonic lipomas are a benign tumor that can present in multiple ways, including; incidentally, abdominal pain, change in bowel habit, bleeding, intestinal obstruction and intussusception. We present the case of a 48-year-old gentlemen who presented to the emergency department with a 3 day history of abdominal pain and was found to have a 5 cm intramural ischemic pedunculated colonic lipoma causing intussusception and large bowel obstruction. He received initial management with emergency laparoscopic exploration, reduction of intussusception, colotomy and lipoma excision. He made a full recovery. The current approaches to management of colonic lipomas are conservative, endoscopic or surgical. This case highlights the potential consequences of untreated colonic lipomas. In our review of the literature, we highlight that there is a lack of clear consensus on appropriate management of these patients.

Successful airway management in a comorbid patient with retrosternal goiter: A case study on lipoma excision and biopsy

Successful airway management in a comorbid patient with retrosternal goiter: A case study on lipoma excision and biopsy

Ulnar Nerve Compression at the Elbow Secondary to Intramuscular Lipoma of the Flexor Carpi Ulnaris: A Case Report.

A 62-year-old right-hand-dominant woman presented with 1 year of persistent radiating pain, weakness, and paresthesias in her left forearm and hand. Electromyography findings were significant for ulnar neuropathy distal to the branch innervating the flexor carpi ulnaris (FCU), without superimposed cervical radiculopathy or other focal entrapment neuropathy. During open ulnar nerve neurolysis, an intramuscular lipoma was encountered within the FCU. Lipoma excision and cubital tunnel release with ulnar nerve transposition were performed with complete relief of neuropraxia. We demonstrate full neurologic recovery after intramuscular lipoma excision and cubital tunnel release. Although rare, anomalous anatomy and tissue overgrowth should remain on the differential for patients presenting with atypical neuropraxia.

Successful Treatment of Refractory Neuropathic Pain Following Axillary Dissection and Lipoma Resection Using Cervical and Thoracic Dorsal Root Ganglion Stimulation

BACKGROUND: Neuropathy is a pain condition that is caused by an insult to the somatosensory system. Providing adequate management of neuropathic pain (NP) conditions can be challenging as the dis-ease may become progressively nonresponsive to conventional therapies. If conventional treatment options prove ineffective, cervical dorsal root ganglion (DRG) stimulation is a relatively effective, off-label-use therapy for NP, which requires expert cervical placement to be completed safely and effectively. The Neuromodulation Appropriateness Consensus Committee guidelines highlight safety features and general indications for DRG stimulation, which includes current on-label usage up to T10. Although this committee’s expert opinions stated that DRG is safe up to the C5 level, there is limited published efficacy and safety data at levels higher than T10. CASE REPORT: A 36-year-old woman with a significant medical history of anxiety developed intractable right upper extremity NP following an axillary dissection for a lipoma excision. De-spite conservative management, she presented with debilitating NP and severe right upper ex-tremity functional restrictions following the procedure. The patient underwent a C8-T1 DRG stimulation trial, which decreased her pain levels over 50%, and significantly increased her functional abilities. Right-sided C8-T1 permanent DRG leads were placed, which resulted in improved sleep, increased ability to use her right upper extremity, a 95% to 97% reduction in pain, and elimination of regularly scheduled analgesic medications. CONCLUSIONS: Cervical and high thoracic DRG was safe and successful in the treatment of right upper extremity NP in the upper dermatomal levels secondary to axillary dissection and lipoma resection. KEY WORDS: Cervical and high thoracic DRG, neuropathic pain, axillary dissection, lipoma re-section, neuromodulation, case report

Seroma prevention with topical Abnobaviscum sclerotherapy following excision of giant cervical lipoma.

Lipomas are common benign tumors of mesenchymal origin that are composed of mature adipocytes. Giant lipomas have a diameter ≥ 10 cm in one or more dimensions or weigh at least 1,000 g. The surgical excision of a giant lipoma requires extensive dissection, increasing the risk of a seroma, which can cause surgical site complications such as wound infection and necrosis. Sclerotherapy with Abnobaviscum (Viscum album extract) is a relatively new technique used to reduce malignant pleural effusion. In this study, we evaluated the effectiveness of prophylactic sclerotherapy using Abnobaviscum to decrease seroma after giant lipoma excision. We conducted a retrospective medical record review of patients who underwent surgical excision for giant lipoma of the neck from January 2019 to December 2022. Sclerotherapy was performed on the first postoperative day in patients who consented to the procedure, and Abnobaviscum was instilled through the existing Hemovac drain. We compared the clinical course between those who underwent postoperative sclerotherapy and those who did not. Among the 30 patients who underwent giant lipoma excision, we applied sclerotherapy with Abnobaviscum to 15 patients. The average time from surgery to Hemovac removal was statistically shorter in patients who underwent sclerotherapy (p= 0.004). Furthermore, seroma formation was significantly reduced in patients receiving sclerotherapy (p= 0.003). In patients undergoing giant lipoma excision, sclerotherapy using Abnobaviscum helps reduce postoperative seroma formation during the initial postoperative period. It can be an excellent method to reduce complications related to seroma and attenuate patients' postoperative burden.

Seroma prevention with topical Abnobaviscum sclerotherapy following excision of giant cervical lipoma

Background: Lipomas are common benign tumors of mesenchymal origin that are composed of mature adipocytes. Giant lipomas have a diameter ≥ 10 cm in one or more dimensions or weigh at least 1,000 g. The surgical excision of a giant lipoma requires extensive dissection, increasing the risk of a seroma, which can cause surgical site complications such as wound infection and necrosis. Sclerotherapy with Abnobaviscum (<i>Viscum album</i> extract) is a relatively new technique used to reduce malignant pleural effusion. In this study, we evaluated the effectiveness of prophylactic sclerotherapy using Abnobaviscum to decrease seroma after giant lipoma excision.Methods: We conducted a retrospective medical record review of patients who underwent surgical excision for giant lipoma of the neck from January 2019 to December 2022. Sclerotherapy was performed on the first postoperative day in patients who consented to the procedure, and Abnobaviscum was instilled through the existing Hemovac drain. We compared the clinical course between those who underwent postoperative sclerotherapy and those who did not.Results: Among the 30 patients who underwent giant lipoma excision, we applied sclerotherapy with Abnobaviscum to 15 patients. The average time from surgery to Hemovac removal was statistically shorter in patients who underwent sclerotherapy (<i>p</i>= 0.004). Furthermore, seroma formation was significantly reduced in patients receiving sclerotherapy (<i>p</i>= 0.003).Conclusion: In patients undergoing giant lipoma excision, sclerotherapy using Abnobaviscum helps reduce postoperative seroma formation during the initial postoperative period. It can be an excellent method to reduce complications related to seroma and attenuate patients’ postoperative burden.Abbreviations: BMI, body mass index; DM, diabetes mellitus; HTN, hypertension; NSAIDs, nonsteroidal anti-inflammatory drugs; POD, postoperative day

Accuracy of Surgeon and Patient Estimated Cost and Reimbursement for Common General Surgical Operations and Benefit of Centers for Medicare and Medicaid Services Price Transparency Rules.

On January 1, 2021, the Centers for Medicare and Medicaid Services implemented a hospital price transparency rule. Consumerism as a means of reducing healthcare expenditure is predicated on informed consumers making discrete choices. For 10 months, immediately after a preoperative clinic visit at an academic medical center, patients and their surgeons were surveyed regarding their estimation of hospital cost and hospital reimbursement for the upcoming operation. Responses were compared to average institutional cost (fiscal year 2019) for Medicare patients undergoing a laparoscopic approach for each operation. We calculated the difference between actual reimbursement and cost with patients' estimates and actual reimbursement and cost with surgeons' estimates. Sixty-six questionnaires were collected from patients who underwent laparoscopic operations, that included cholecystectomy (n = 20), inguinal hernia (n = 17), umbilical hernia repair (n = 6), ventral hernia repair (n = 6), incisional hernia (n = 6), hiatal hernia repair (n = 1), and lipoma or cyst excision (n = 10). Patients' estimates of hospital cost exceeded actual hospital cost by a median of $4,502 and were less than hospital reimbursement by a median of $1,834. Surgeon estimates for direct cost were $825 less than hospital direct cost and $1,659 less than hospital reimbursement. Patients as well as their surgeons do not estimate healthcare cost or remuneration accurately and therefore will be ineffective change agents in reducing surgical spending based on price transparency without further education of both parties. Patients consistently overestimated surgical cost while surgeons consistently underestimated surgical cost and reimbursement. It is likely that better-informed surgeons and patients are necessary prerequisites for Centers for Medicare and Medicaid Services price transparency rules to be effective in reducing Medicare expenditures in surgery.

Large soft-tissue mass in the extremity is not necessarily a sarcoma: A case report of a giant lipoma of the thigh

Lipoma is the most common benign adipose tissue tumor. Giant lipomas are those that measure more than 10 cm in length or more than 1000 g in weight. There is a possibility of sarcomatous change in them but it is not always the rule. Lipoma and liposarcoma can be differentiated on the magnetic resonance imaging features of tumor size, stranding, nodularity, T2 signal, and contrast enhancement. The existence of thin septa helps identify lipomas and distinguishes them from well-differentiated liposarcomas, which have thick and irregular septa and fat necrosis at times. The open surgical approach is the best for the complete excision of giant lipomas without any recurrence.

MANAGEMENT OF A GIANT LIPOMA IN THE AXILLA: A CASE REPORT

Lipomas are the most common benign mesenchymal tumors in adults. Generally, they are less than 5 cm in size but sometimes they can present as giant lipomas. Axillary region is an unusual localization for lipomas in general, especially for giant lipomas. A case of a 62-year-old male with a giant lipoma in the axillary region is presented. The tumor was located in the left axillary region beneath the pectoralis major muscle and extended all along to the scapula. It was adjacent to the axillary vessels and the brachial plexus, but did not invade the neurovascular bundle. A team of a plastic and thoracic surgeon performed the operation. The pathology report confirmed a benign lipoma weighting 454 grams and measuring 13.5x8x7 cm. Follow-up examinations (clinical examination and ultrasound) revealed no recurrence three years after the operation. The mechanism of lipoma formation is not completely clear. It includes two potential and overlapping mechanisms in which trauma seem to have the major role. The treatment includes surgical excision or liposuction. However, excision of large lipomas can sometimes be a surgical challenge. Giant lipomas in axillary region should be removed in order to establish the pathohistological diagnosis and to prevent possible compression of the neurovascular structures. In our opinion, surgical excision is a preferred method of treatment because there is less possibility of damaging vital structures and it offers better control against local tumor recurrence.

Recurrence Rate after Marginal Excision of Lipomas

Background and Aim: Lipoma is a benign tumor composed of mature adipocytes. This study was performed on patientswith histologically diagnosed and confirmed lipomas to evaluate clinical outcome after marginal excision of the tumorsand to determine whether local recurrence had any correlation with patient age and sex, or tumor size and location.Materials & Methods: The present is the retrospective analysis that examined the 100 patients diagnosed with lipomas. Thetumor in all the patients was found to be deeply seated and ultrasounded guided biopsy was performed preoperatively.The margins of soft tissue resections of the tumor specimens were defined as (1) intralesional, (2) marginal and (3) wide.The margins were marginal in all cases; none of the patients had any treatment other than surgery.Results: It was found that Lipomas had an equal predilection for upper and lower extremities. The results of the studyshowed that none of the patients had any local recurrence. No patient had experienced metastasis at the time of this study.Local recurrence did not correlate with patient age or sex for patients with lipomas, neither with size or location of thetumors.Conclusion: The present study shows that histological analysis provides for accurate diagnosis of lipomas. The recurrencesrate in the patients with tumor was not found in any of the above patients where marginal excision was planned. Therewas no relationship seen in patient age, sex, sie and location of the tumor. However to overcome the limitation of thestudy, the long term follow up is recommended for the further studies.

Using a Virtual Reality and Communication Intervention to Reduce Pain and Anxiety in Patients Undergoing Lipoma Excision With Local Anesthesia: A Randomized Controlled Trial.

In this randomized controlled trial, we assessed the effects of using a virtual reality (VR) and communication intervention on pain and anxiety in patients undergoing lipoma excision under local anesthesia. We conducted the study at a large hospital in Turkey between March 15 and September 15, 2019, with 100 participants. We used a pretest and posttest design to collect data with a personal information form, the Numeric Pain Rating Scale, and the State-Trait Anxiety Inventory. The intervention group participants watched a video using a VR headset during the procedure and communicated with an investigator; the control group participants only received routine surgical treatment. The intervention had a significant effect on pain during the procedure (P < .001) and a moderate effect on anxiety 60 minutes after the procedure (P = .01). Use of VR and active communication may help reduce pain and anxiety for patients undergoing procedures performed with local anesthesia.

Superficial Cervical Plexus Block for Retroauricular Mass Excision in a Patient with High Risk of General Anaesthesia: A Case Report.

The surgical procedure of lipomas is performed under local, regional, or general anaesthesia depending on the location, number, and size of the lipoma. Anaesthesia can be achieved with a superficial cervical plexus block in the short-term surgery of soft tissue lesions in the dermatome areas of the lesser occipital nerve and great auricular nerve. In this article, we presented a high-risk patient with comorbid diseases and difficult airway who underwent superficial cervical plexus block for retro-auricular lipoma excision.

A unique method for management of benign colonic masses: case report

Even though lipomas are most common non-epithelial tumors of the large intestine, they mostly present with non-specific symptoms. Intussusception is the most common morbidity related to such lesions and may present as intestinal obstruction. We present here a case of a young female who presented to gastroenterology department as a case of pain abdomen and nausea and a provisional diagnosis of subacute intestinal obstruction was kept. Contrast enhanced CT confirmed a diagnosis of intussusception due to an ascending colon mass? likely lipoma. The colonoscopy was done and biopsy was taken which was non-specific for malignancy. Patient, after taking due consent, was taken for surgery and laparoscopic assisted submucosal excision of lipoma was done and we will discuss the same. Endoscopic excision of lipomas has been reported but when failed, mostly segmental resection of the colon has been reported. To the best of our knowledge, this is the second reported case of laparoscopic assisted colotomy with submucosal excision of an intussuscepting colonic lipoma and first one in ascending colon.

EP.FRI.874 Laparoscopic Assisted Submucosal Excision of an Intussuscepted Colonic Lipoma through a Colotomy; A New Technique

Abstract Lipomas are the most common non-epithelial tumours of the colon. Nevertheless, symptomatic colonic lipomas are a rare entity in adults. Intussusception is the commonest complication of submucosal lipomas and often presents with absent, non-specific or intermittent symptoms, hence the diagnosis is challenging. In non-emergency situations, most patients undergo computed tomography scan as well as endoscopic evaluation of the colon prior to any surgical intervention. While successful endoscopic excision of lipomas has been reported, segmental resection of the colon is most commonly practiced. To the best of our knowledge, this is the first report of laparoscopic assisted submucosal excision of an intussuscepting colonic lipoma through a colotomy. We present the case of a young female patient with few weeks history of intermittent abdominal pain associated with nausea. She had previously undergone various investigations including colonoscopy and was awaiting an elective left hemicolectomy. She presented to our Emergency department with subacute large bowel obstruction. A CT scan confirmed the diagnosis of colo-colic intussusception due to a large descending colon lipoma. The patient underwent a laparoscopic assisted procedure - following laparoscopic colonic mobilisation, submucosal excision of the large lipoma was performed through a colotomy placed through the taenia on the opposite wall. The mucosal defect and colotomy were closed following the excision. The patient recovery was uneventful and histopathology of the specimen confirmed the diagnosis.

Use of Telehealth for Routine Postoperative Care in a Safety-Net Population

Introduction: Perceived barriers have historically limited telehealth to high-income settings. The COVID-19 pandemic necessitated changes in surgical care, including expanded telehealth access. This study aims to evaluate telehealth’s use for routine postoperative care at an urban safety-net hospital. We hypothesized that completion rates for telehealth would be higher than in-person follow-up, with no difference in the rate of complications. Methods: We performed a retrospective chart review of 410 patients undergoing inguinal hernia repair, appendectomy, cholecystectomy, and lipoma excision, from September 2019 to September 2020. We compared demographics, social determinants of health, co-existing conditions, and appointment completion between in-person and telehealth follow-ups, using univariate methods. Outcomes of interest were 90-day complications, 30-day surgery-related Emergency Department visits, and readmissions and reoperations. Results: Review identified 115 appendectomies, 168 cholecystectomies, 119 inguinal hernia repairs, and 10 lipoma excisions, with 54.4% urgent/emergent. Overall, 84.9% of surgical follow-ups were completed. Preliminary results from patients who underwent appendectomy showed that 15.6% of patients had telehealth and 55.1%in-person postoperative visits. Interpreters were required for 48.7% of patients, 31.3% had a primary care provider at the time of surgery, and 23.5% had unstable housing. The no-show rate for telehealth was 17.6%, compared to 11.7% for in-person visits (p=0.5). The NSQIP-predicted risk of complication was 4.0% in the telehealth and 4.1% in the in-person group;observed complication rates were11.8% for telehealth and 5.0% for in-person follow-up (n=8, p=0.3). Conclusion: In a safety-net population, preliminary results suggest similar rates of visit completion and complication for routine postoperative telehealth. [Formula presented]

Minimal One-Third Incision and Four-Step (MOTIF) Excision Method for Lipoma.

Excision is the gold standard for lipomas. Patients desire minimal scars, but minimal incisions can increase complications and produce hypertrophic scars. We propose an algorithmic method named the minimal one-third incision and four-step extraction method (MOTIF) for lipoma excision. This retrospective study analyzed lipomas surgically excised using the MOTIF method at our institution between January 2016 and December 2018. A total of 112 lipomas were included. The complication rates and Vancouver Scar Scale (VSS) for three different size groups (<3 cm, 3 ~ 6 cm, >6 cm) were compared. Complete excision of all palpable lipomas was achieved with this approach. There were two seromas, two hematomas, and one postoperative nerve injury. There was no difference in complication rates and VSS between the three size groups. The MOTIF method is a cost-effective, reliable, and cosmetically pleasing method that can be applied to all lipomas regardless of size and location.

Peripheral Field Nerve Stimulation in Refractory Subcutaneous Persistent Postsurgical Pain

Background: The mechanistic underpinnings of nerve stimulation technology is an area of active debate in interventional pain literature. Whether the technology is transcutaneous, subcutaneous, or directly on the spinal cord/dorsal root ganglion, there are ample theories without substantive evidence. Although, these technologies have been proven to be invaluable for pain relief. Direct spinal cord stimulation is purported to be effective for peripheral pain through centrally mediated stimulation. However, in select cases, there is evidence for superior analgesia from a peripherally directed device, such as a subcutaneously placed peripheral field nerve stimulator (PFNS), when compared to spinal cord stimulators (SCS). Case Report: An 81-year-old man was referred for left upper thoracic pain exacerbated by lipoma excision with diagnostic imaging unsupportive of musculoskeletal etiology. The patient was found to have soft tissue tenderness to palpation worsened by activity. He failed numerous conservative treatments and procedures. An epidural SCS was trialed, with appropriate paresthesia mapping, but was unsuccessful in providing significant relief. Ultimately, a PFNS was trialed and found to provide adequate relief. A PFNS was later implanted, resulting in successful pain relief. Conclusion: The case demonstrates the importance of developing evidence-based guidelines for the application of PFNS. Additionally, it is important to delineate the shared and unique targets of nerve stimulator technologies so that patients may minimize risk through trial-and-error procedures. Key words: Surgical procedures, operative, spinal cord stimulation, refractory pain, paroxysmal nerve pain, intractable pain, electric stimulation therapy, back pain without radiation,transcutaneous electric nerve stimulation

Medical services provided on the ‘Harmonious Mission—2017’ Peace Ark from China

IntroductionThe Chinese Naval ship Peace Ark provided humanitarian medical services to people in eight low-income countries in Africa and Asia during the 2017 “Harmonious Mission’. The expedition lasted 155 days....