Laparoscopic Cyst Research Articles

Robot-assisted treatment of simple renal cysts

BACKGROUND: The gold standard in the surgical treatment of simple renal cysts is laparoscopic cyst fenestration. However, laparoscopic procedures have disadvantages which include poor ergonomics of the instruments hindering surgeon's work in children's small abdomen. Robot-assisted surgery has the potential to make surgeon's work easier and to improve surgical outcomes in patients with kidney cysts for the instruments have seven degrees of freedom, hand tremor is filtered. It also promotes comfortable console positioning for the surgeon, and three-dimensional wide-angle imaging of the surgical field. AIM: To present the first experience of applying robot-assisted surgery for fenestration (decortication) of the outer portion of the cyst and argon-plasma coagulation of its inner lining. METHODS: The author's present retrospective data of all patients with simple renal cysts operated on with robot-assisted approach at the Irkutsk State Regional Children's Clinical Hospital. The diagnosis was put after ultrasound examination of kidneys and after computed tomography with intravenous contrast agent. Surgery was performed using a new model of the Versius robotic system manufactured by Cambridge Medical Robotics (UK). RESULTS: Patients' mean age at the time of surgery was (13±5.3) years (median 15 [11; 16] years), mean weight — (46.7±17.2) kg (median 54 [40.5; 56.5] kg), smallest body weight — 27 kg, size of cysts — (1.8±2.4) cm (median 0.4 [0.4; 2.5] cm). Cystic formations in all patients were located on the left: in the upper pole in 2 patients, in the lower pole in 1 patient. During the surgical intervention, there were no complications in the form of bleeding from the kidney parenchyma or damage to neighbouring organs. Histological analysis revealed that the lining of the cyst wall contained transitional epithelium without signs of malignancy. Duration of surgery was (136.7±72.2) min (median 95 [95; 157] min), duration of patients' stay in the intensive care unit — (19.9±2.5) hours (median21.3 [19.1; 21.4] hours), duration of hospital stay — (9.3±2.3) days (median 8 [8; 10] days). Ultrasound examination made in 1, 3 and 6 months after the surgery revealed no signs of disease recurrence in the form of residual accumulation of fluid associated with kidney parenchyma. CONCLUSION: The experience described in the article is encouraging and confirms the reasonability and safety of robot-assisted procedures in pediatric urology.

Midpoint transverse process to pleura block for postoperative analgesia following laparoscopic renal cyst decortication: Two case reports

BACKGROUND The midpoint transverse process to pleura (MTP) block, a novel technique for thoracic paravertebral block (TPVB), was first employed in laparoscopic renal cyst decortication. CASE SUMMARY Thoracic paravertebral nerve block is frequently employed for perioperative analgesia during laparoscopic cyst decortication. To address safety concerns associated with TPVBs, we administered MTP blocks in two patients prior to administering general anesthesia for laparoscopic cyst decortication. The MTP block was performed at the T9 level under ultrasound guidance, with 20 mL of 0.5% ropivacaine injected. Reduced sensation to cold and pinprick was observed from the T8 to T11 dermatome levels. Immediately postoperative Numeric Pain Rating Scale scores were 0/10 at rest and on movement, with none exceeding a mean 24 h numeric rating scale > 3. CONCLUSION MTP block was effective technique for providing postoperative analgesia for patients undergoing laparoscopic renal cyst decortication.

Thirty-eight cases of paraovarian cysts in children and adolescents: a retrospective study.

Paraovarian cysts in children and adolescents can be challenging to accurately diagnose prior to surgery. Our objective is to outline the clinical characteristics of paraovarian cysts and enhance the precision of diagnosing paraovarian cysts in this age group. We retrospectively analyzed all patients with paraovarian cysts who underwent surgery in our department from 2013 to 2021. The review focused on demographic characteristics, clinical manifestations, intraoperative findings, and postoperative pathology of these patients. This cohort was composed of 38 children with paraovarian cysts. The average diameter of the cysts was 4.8cm (range 0.5-10cm). Among the cases, 25 (65.8%) had adnexal torsion. Postoperative pathology showed that all cases were simple cysts with serous fluid. After the procedure, the patients were monitored for a period ranging from 12 to 108 months. B-ultrasound and physical examination did not reveal any significant abnormalities. B-ultrasound can help diagnose paraovarian cysts by detecting slight deviation movement between the cyst and the uterus. The presence of adnexa torsion in children and adolescents with paraovarian cysts does not depend on BMI, but rather on the size of cysts. Laparoscopic cyst removal has proven to be an effective surgical approach with favorable outcomes.

Intra-axial Hepatic Cerebrospinal Fluid Pseudocyst: An Unusual Complication of Ventriculoperitoneal Shunt Placement

Intra-abdominal Cerebrospinal Fluid (CSF) pseudocysts are a well-known and potentially serious complication of Ventriculoperitoneal (VP) shunt placement. These cysts are often found within the peritoneal cavity or along the serosal surface of solid organs. Here, we present an unusual case of an intrahepatic CSF pseudocyst in a 14-year-old female patient with a VP shunt placed three years ago, following the excision of a cerebellar pilocytic astrocytoma. The child presented with complaints of right hypochondriac pain and tenderness for one month. On ultrasound of the abdomen, the right lobe of the liver showed a complex anechoic cystic collection with multiple thick internal septations. A Contrast-enhanced Computed Tomography (CECT) examination revealed a well-defined hypodense collection in segments IV and V of the liver with a VP shunt tube within. Based on clinical and imaging features, differentials of intra-axial intrahepatic CSF pseudocyst, complex hepatic cyst, peri-shunt hemorrhagic cyst, and biliary cystadenoma were considered. Aspiration of the cyst revealed clear, colourless, non purulent, non sanguineous fluid which tested positive for beta-2-transferrin, confirming the collection to be a CSF pseudocyst. An elective laparoscopic cyst excision with shunt revision was performed with no recurrence on follow-up. The present case highlights the uncommon occurrence of intrahepatic CSF pseudocysts post-VP shunt, necessitating meticulous diagnostic evaluation. Successful laparoscopic excision and shunt revision underscore the efficacy of tailored interventions. This contribution enhances the understanding of atypical complications in VP shunt recipients, guiding clinicians and radiologists in both diagnosis and management.

#265 : Oocyte Outcome After Laparoscopy Cyst Drainage Procedure Before IVF Stimulation in Endometriosis Patients

Background: Endometriosis is the presence of endometrial-like tissue outside the uterine cavity. In late years, in order to control endometriosis, we often performed cystectomy either laparoscopy or laparotomy. However, cystectomy done in endometriosis patient undergoing IVF can decrease the AMH also the quality of the oocytes, thus cyst drainage procedures (with the insertion of hemostate agent) was considered as a replacement for cystectomy in endometriosis patients before they begin the IVF stimulations. Aims: To see the effect of laparoscopic cyst drainage with the insertion of an absorbable hemostate towards the quality of the oocytes in endometriosis patient Method: A retrospective cohort study took place at Center of Reproductive Medicine and Andrology Bocah Indonesia in Primaya Hospital, Tangerang between January 2021 and December 2022. Patients with endometriosis cysts before IVF stimulations were all included. Excluded were those declining to participate and with incomplete case notes. All of the subjects used ultra-long GnRH agonist protocols. A medical committee approved the study and all women provided written informed consent. Results: 18 patients were included in the analysis (11 undergoing laparoscopy cyst drainage and insertion absorbable hemostatic agent’s vs 7 undergoing only cystectomy). There was a statistically significant difference in AMH values in patients with cystectomy vs drainage with an absorbable hemostatic agent in AMH values 1.002 ± 0.76 to 0.77 ± 0.76 vs 1 (0.30 – 3.31) to 1 (0.30 – 4.00) (p=0.003 vs p =0.678). Among those, there was no significant difference between cystectomy and drainage with the maturation of oocyte (p=0.231 vs p=0.381). On the other side, there was a significant difference between cyst drainage and cystectomy resulting in good embryos in cleavage (p=0.038). One of the patients has a naturally conceive pregnancy after a cyst drainage procedure. Conclusion: Endometriosis with laparoscopic cyst drainage procedure can maintain AMH level, reduce inflammation, and proliferation of lesions so it can maintain better quality of oocytes.

Comparison of open and laparoscopic outcomes of adult Type-I congenital choledochal cysts.

To compare open and laparoscopic outcomes of adult Type-I congenital choledochal cysts. Clinical data of 78 adult patients with Type-I congenital choledochal cysts, who had undergone cyst resection and Roux-en-Y hepaticojejunostomy in Chenzhou First People's Hospital from September 1, 2021 to August 31, 2022, were retrospectively analyzed. Patients who received open approach and Roux-en-Y hepaticojejunostomy constituted the open group (n=35,) and patients who received laparoscopic approach and Roux-en-Y hepaticojejunostomy were assigned into the laparoscopic group (n=43,). The intraoperative and postoperative conditions, relevant laboratory indicators, and the rate of complications were compared between the two groups. Intraoperative blood loss, postoperative time to first flatus, diet recovery time, time to drainage tube removal, and length of hospitalization of the laparoscopic group were lower in the laparoscopic group compared to the open group (P<0.05). One day after the operation, serum amylase (SAMY) levels in both groups were significantly lower, while the levels of total bilirubin(TBIL), alanine aminotransferase(ALT), and C-reactive protein(CRP) were higher than before the operation. Postoperative SAMY level in the laparoscopic group was significantly higher, while the postoperative TBIL and CRP levels were significantly lower than those in the open group (P<0.05). The incidence of postoperative complications in the laparoscopy group (4.65%) was significantly lower than the open group (20.00%) (P<0.05). Laparoscopic cyst resection combined with Roux-en-Y hepaticojejunostomy is associated with lower extent of trauma, faster recovery, less inflammation, and fewer complications than open surgery in adult patients with Type-I congenital choledochal cysts.

European Paediatric Surgeons' Association Consensus Statement on the Management of Neonatal Ovarian Simple Cysts.

Neonatal ovarian simple cyst management from the pediatric surgical aspect is unclear on cyst size, follow-up, and preferred surgical approach. Therefore, this topic was selected for the 2022 Consensus Session meeting of the European Paediatric Surgeons' Association (EUPSA). The literature was reviewed on a predefined set of questions relating to the management of the neonatal ovarian simple cysts by a panel of 7 EUPSA members, on current evidence-based opinion and practice outlined. Each question (1) outcomes of fetal interventions in neonates after birth and consensus on size/timing of intervention, (2) consensus on the type of interventions, and (3) complications in neonatal ovarian cysts and follow-up recommendations in nonoperated/operated cysts, was presented with available evidence to congress session participants. The management approach was agreed by participants and comments were accounted to formulate the consensus statement. There is still limited data on potential benefits and complications of prenatal ultrasound-guided aspiration; however, neonates after such procedures should be followed for 6 months. Neonates with simple ovarian cysts larger than 4 cm should be offered surgical interventions within the 2 weeks of life with complete laparoscopic cyst aspiration and fenestration with bipolar instruments being the preferred approach. Ultrasound follow-up after surgical intervention after 3 months and with the conservative approach after every 3 to 4 months until 1 year. A peer-reviewed consensus statement for the management of neonatal ovarian simple cyst was formulated based on current evidence and peer practice. The EUPSA recognizes that the statement can be useful for pediatric surgeons in decision making for this pathology.

Proctoring System of Pediatric Laparoscopic Surgery for Choledochal Cyst.

Background: Endoscopic surgery also has been becoming widespread in the field of pediatric surgery. However, most disease treated by pediatric surgery in a single institution are small number of cases. Besides, the variety of operative procedures that need to be performed in this field is quite wide. For these reasons, pediatric surgeons have limited opportunities to perform endoscopic surgery. Therefore, it is difficult to introduce advanced endoscopic surgery at a single local hospital. To educate pediatric surgeons in local hospitals, for widespread advanced pediatric endoscopic surgery safely, and to eliminate the need for patient centralization, we have introduced a proctoring system. We compared the surgical results of our institution, a center hospital, with other local institutions, to investigate the feasibility of our proctoring system. Methods: The experienced pediatric surgeon of our institution visits local hospitals to provide onsite coaching and supervises pediatric surgeons on the learning curve. All patients who underwent laparoscopic cyst excision and hepaticojejunostomy for choledochal cysts, one of the advanced pediatric endoscopic surgeries was retrospectively reviewed. Results: Thirty-four cases were evaluated (14 cases in our institution, 20 cases in 9 other institutions). The procedures of all 34 cases were performed by surgeons with 0-2 cases of experience in the procedure. There were no open conversion cases. There was no significant difference in the operative date. There was 1 case (6.7%) of postoperative complications during hospitalization at our institution and 3 cases (14.3%) at other institutions (P = .47). Two cases of late complications (13.3%) occurred at our institution, whereas 6 cases (28.6%) occurred at other institutions (P = .28). Conclusion: With the proctoring system, the performance and completion of advanced pediatric endoscopic surgery at local institutions was feasible. This has important implications given the ever-growing demand for pediatric endoscopic surgery and the increasing need for competent pediatric endoscopic surgeons.

Risk factors analysis for clinical symptoms of prenatally diagnosed choledochal cysts: a retrospective study

BackgroundThis study aimed to screen the impact factors for clinical symptoms of prenatally diagnosed choledochal cysts (CDCs), to warn about the occurrence of clinical symptoms and the timing of surgery.MethodsMedical records of patients with prenatally diagnosed CDCs admitted to our hospital from April 2013 to April 2018 were retrospectively reviewed. Fetal hilar or abdominal cysts were found by prenatal ultrasonogram. All patients underwent laparoscopic cyst excision and hepaticojejunostomy in our center. Univariate analysis and multivariate logistic regression analysis were performed to screen the factors related to clinical symptoms intimately.ResultsTwo hundred eighteen cases were included. One hundred thirty-four patients (134/218, 61.5%) presented clinical symptoms before surgery. The results of univariate analysis showed that patients with clinical symptoms had earlier time of prenatal diagnosis (P = 0.002), higher values of GGT, TBIL, DBIL (P < 0.001, P < 0.001, P < 0.001, respectively) and larger maximum diameter of cyst before surgery (P = 0.012). Multivariate logistic regression analysis suggested that the time of prenatal diagnosis (P = 0.001, OR = 0.898, 95% CI: 0.845 ~ 0.955) and the GGT value within one week of life (P = 0.028, OR = 1.002, 95% CI: 1.000 ~ 1.003) were independent influencing factors for symptoms.ConclusionsFor children with prenatally diagnosed CDCs, approximately 2/3 patients presented noticeable clinical symptoms before surgery. The time of prenatal diagnosis and the GGT value within 1 week of life were independent impact factors for the occurrence of clinical symptoms.

Watchful waiting for large primary nonparasitic splenic cysts.

Primary nonparasitic splenic cysts (NPSC) are typically diagnosed incidentally. The management of large (≥ 5 cm) asymptomatic cysts remains controversial; there is a lack of evidence guiding management. The purpose of this study was to describe the outcomes of nonoperative management of large NPSC. Patients diagnosed with NPSC between January 2004 and December 2019 were identified at our academic institution. Adult patients with an NPSC of at least 5 cm who had at least 1 additional hospital visit were included. Data are presented as medians with interquartile ranges (IQR). We identified 512 medical records that included the term splenic cyst during the study period. Sixty-eight of the patients had no reported cyst size, 410 had cysts smaller than 5 cm, 1 patient underwent an elective splenectomy at another institution and 12 patients were excluded for other reasons; 21 patients with cysts of at least 5 cm were included in the study. Eight symptomatic patients underwent surgery at our institution. Of these, 2 presented acutely: 1 with hemoperitoneum who required admission for transfusions and later underwent elective laparoscopic splenectomy and 1 with increasingly severe abdominal pain who underwent laparoscopic cyst unroofing. The remaining 6 symptomatic patients had elective surgery for pain (4 cyst unroofing, 1 total splenectomy, 1 partial splenectomy). Thirteen patients were asymptomatic (10 female, median age 49.2 [IQR 38.1 to 64.6] yr). Two of these patients chose to undergo elective surgery. The remaining 11 asymptomatic patients, with a median initial cyst size of 8.0 (IQR 5.3 to 10.8) cm, were followed for a median of 31.0 (IQR 23.5 to 71.0) months. There was no change in median cyst size (0 [IQR -1 to 0] cm), and none of these patients underwent intervention for their NPSC. Asymptomatic patients managed nonoperatively for large NPSC did not become symptomatic or require intervention during the study period. This supports watchful waiting with serial radiologic and clinical monitoring for asymptomatic large NPSC.

Clinical efficacy of ultrasound-guided interventional therapy in patients with benign ovarian cysts: a meta-analysis

This study aimed to explore the clinical efficacy of ultrasound-guided interventional therapy in patients with benign ovarian cysts through meta-analysis. A literature search was performed on PubMed, Web of Science, Embase, CNKI, and WanFang databases to obtain clinical randomized controlled trials on ultrasound-guided interventional therapy for benign ovarian cysts published between 2010 and 2022. A total of 1395 studies were initially retrieved, and finally 12 studies were included for meta-analysis. The results showed that the observation group (ultrasound-guided interventional therapy) had higher treatment effective rate than the control group (conventional laparotomy or laparoscopic cyst resection), but the incidence of adverse reactions was markedly lower. Additionally, the length of hospital stay, intraoperative blood loss, and operation time showed significant lower levels in the observation group. In terms of ovarian function, postoperative luteinizing hormone and follicle-stimulating hormone levels in the observation group were lower than the control group, while oestradiol levels were higher. In conclusion, compared with conventional surgical treatment, ultrasound-guided interventional therapy can significantly improve the clinical effective rate, shorten the hospital stay and reduce intraoperative blood loss. Such therapy can protect ovarian reserve, with high value of clinical promotion. IMPACT STATEMENT What is already known on this subject? Main surgical methods for ovarian cysts consist of laparotomy, laparoscopic surgery, and interventional therapy. What the results of this study add? With the advancement of surgical techniques and instruments, many minimally invasive surgeries have been applied to treat ovarian cysts with good clinical results. However, there is no exact evidence to prove its clinical efficacy. Given the lack in this field, we conducted a meta-analysis of all clinical studies of ultrasound-guided interventional therapy for ovarian cysts to evaluate its efficacy and safety. What the implications are of these findings for clinical practice and/or further research? Compared with conventional laparotomic or laparoscopic cyst resection, ultrasound-guided interventional therapy for ovarian cysts significantly improves the treatment effectiveness, shortens the hospital stay and reduces intraoperative blood loss. This therapy with good clinical efficacy also has advantages of small wound, rapid recovery and less adverse reactions, and can protect ovarian reserve. This safe and effective surgical method for ovarian cysts is worth promoting clinically.

Robotic-assisted laparoscopic management of mesenteric cysts in children.

Mesenteric cysts (MCs) are rare intra-abdominal masses in children, and laparoscopic complete cyst resection is still difficult. This study reviewed our experience in diagnosing and managing MCs at our center, focusing on the clinical characteristics of MCs and the effectiveness of robotic-assisted laparoscopic surgery. We conducted a retrospective analysis of the records of all patients diagnosed with MCs and managed with robotic-assisted laparoscopic surgery at our center between February 2021 and August 2022. We analyzed demographic characteristics, clinical manifestations, preoperative imaging data, surgical methods, postoperative complications, and final outcomes. Totally, 12 consecutive patients with a mean age of 5.81 ± 3.02 years were admitted. The most common symptom was abdominal pain (58.33%). Eight patients were associated with cyst complications, including five cases of infection, two cases of volvulus, and one case of hemorrhage. The mean size of cysts was 8.39 ± 5.91 cm. The cysts were located in ileal mesentery in eight cases, lesser curvature of the stomach in two cases, and colon mesentery in two cases. Solely cyst excision was performed in eight cases, and bowel en bloc resection of the cyst in four cases. Robotic-assisted laparoscopic surgery was performed successfully in all patients, without conversion. The mean operation time was 106.17 ± 33.74 min. Pathological results reported lymphangioma or lymphatic malformation in all patients. Two cases of chylous leakage were treated conservatively, and no complications of peritoneal infection, anastomotic leakage, and recurrence were observed. Mesenteric cysts should be removed promptly once the diagnosis is confirmed to avoid cyst complications. For uncomplicated mesenteric cysts, laparoscopic cyst excision, or cyst excision with bowel resection can be effectively performed in children, especially under the robot system.

Laparoscopic cyst enucleation is a promising technique for treatment of gastrointestinal tract duplications in children

BackgroundLaparoscopic cyst enucleation has its advantages and limitations in treatment of gastrointestinal tract (GIT) duplications. It allows to avoid bowel resection in such locations as ileocecal valve. We introduced laparoscopic cyst enucleation with further bowel plasty using cyst muscle layer and without monopolar coagulation, for cyst dissection we used straight scissors. Materials and methodsOur study included 20 children with GIT duplications, who underwent cyst enucleation from 2018 to 2021. Laparoscopy was performed in all cases with various cyst locations (stomach – 2, duodenum – 3, small bowel – 14, ileocecal area – 1). Mean age of surgery was 40 ± 35,3 days (min 6 days, max 150 days). ResultsMean operation time was 84,4 ± 27,35 min (min – 40 min, max – 160 min). We had no intraoperative complications. All patients received parenteral feeding for 3–5 days after the operation. Postoperative complications occurred in 3 cases: bowel perforation which required enterostomy (10%) and bowel volvulus required resection (5%). To our opinion, perforations occurred due to monopolar coagulation used for cyst enucleation in these children. No complications were observed in patients who underwent enucleation by straight scissors. Mean postoperative hospital stay was 15.6 ± 10.48 days (min – 4 days, max – 58 days). We observed neither stenosis nor any other complications in the long-term follow-up. ConclusionsLaparoscopic cyst enucleation is a feasible and safe approach for GIT duplications. It allows to avoid bowel resection, and the use of straight scissors instead of monopolar coagulation provides less postoperative complications such as perforation. The Level of evidenceIII.

A CASE SERIES ON SURGICAL MANAGEMENT OF HYDATID CYST OF LIVER IN A TERTIARY CARE CENTRE OF EASTERN INDIA

Introduction: Hydatidosis, a zoonotic disease is still of major concern in developing countries. Although it can involve any organ, liver is most commonly affected. The diagnosis, apart from the varied history and physical signs, involves specic serological tests and radiological techniques. We present this case series to describe our institutional experience in managing this condition. This series was conducted at a Methodology: tertiary care center of eastern India from January 2021 to July 2022. All patients managed surgically with a denitive diagnosis of hydatid cyst of liver on computerised tomography (CT) scan with or without symptoms were included in the study. Open or laparoscopic cyst excision was performed and postoperatively followed till 3 months. The series had a male predomi Results: nance (72%) with 46.7 years being the mean age. Abdominal pain was the most consistent presenting complain (100%) followed by abdominal mass (40%). Right lobe of liver was involved in 76% cases. Surgical site infection (16%) followed by biliary leak (12%) was the most common postoperative complication encountered. The mean length of hospital stay was 10.1 days with 2 cases presenting with recurrence in the 3 month follow up period. This series highlights Conclusion: the clinical presentation, preoperative diagnosis and management of liver hydatidosis with an emphasis on the need of clinical suspicion. A knowledge of surgical approaches and post operative complications is necessary to appropriately tackle such cases.

S3022 Hepatic Cerebrospinal Fluid Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunt

Introduction: Ventriculoperitoneal shunts (VPS) are commonly used in the management of hydrocephalus to drain cerebrospinal fluid (CSF) into the peritoneal cavity. The placement of VPS has prolonged the survival of patients with hydrocephalus. Abdominal pseudocysts are long-term complication of VPS that are identified later in life. Hepatic CSF pseudocyst is a rare long-term complication of VPS that should be differentiated from other cystic lesions of liver. Case Description/Methods: A 49-year-old man with intellectual disability from congenital hydrocephalus s/p placement of right and left-sided VPS at age of 3 months and 7 years respectively presented with exertional dyspnea and abdominal distension. On presentation his vitals were unremarkable except tachycardic (115/min)., He had abdominal distention, hepatomegaly but no tenderness. Initial labs showed D-dimer 2.20 mcg/mL, AST 27 u/L, ALT 38 u/L, alkaline phosphate 126 u/L and total bilirubin 0.5 mg/dL. Chest CT with IV contrast was negative for pulmonary embolism, however revealed a large 18x13x13.5 cm cyst in right hepatic lobe. CT abdomen and pelvis demonstrated a 17.5x12.6x12.7 cm cystic lesion in the right hepatic lobe with the tip of VP shunt catheter within cyst cavity. Hepatobiliary nuclear scan was unremarkable for any biliary leak or sphincter of oddi dysfunction. CT head was negative for any acute abnormalities. Shunt series x-rays were negative for disruption of VPS catheter. Robotic laparoscopic cyst fenestration with partial hepatectomy was performed and catheter was repositioned to the right lower quadrant of abdomen. Patient was discharged home two days later with significant reduction of cyst size on follow up imaging. (Figure) Discussion: This case illustrates a rare complication of VPS that result in hepatic CSF pseudocyst. If hydrocephalus is absent, patients with hepatic CSF pseudocyst are asymptomatic at earlier stages., or they may present with abdominal pain, distention, or palpable right upper quadrant abdominal mass. A subset of patients with hepatic CSF pseudocyst are complicated with bacterial or parasitic infection and present with abdominal pain, distention, or right upper quadrant mass. Abdominal ultrasound and CT scan assist in diagnosis by identifying the tip of VPS catheter in the pseudocyst cavity. Asymptomatic patients are managed conservatively while surgical repositioning of VPS catheter with or without cyst fenestration or surgical excision of cyst may be required for complete resolution of symptoms.Figure 1.: CT of abdomen showing a large right hepatic lobe cyst with evidence of tip of right VPS catheter within the cavity of the cyst (arrows) on transverse (A), axial (B) and lateral (C) views. CT scan of the head (D) showing VPS catheters both in right and left lateral ventricles without evidence of ventricular dilation. Shunt series x-ray (E) shows now distortion of VPS catheter. Robotic laparoscopic cyst fenestration (F) shows VPS catheter within cyst cavity containing CSF.

Ciliated hepatic foregut cyst: A case report and review of literature.

IntroductionCiliated hepatic foregut cyst (CHFC) is a rare cystic lesion that arises from the embryonic foregut with approximately 100 cases reported. Most commonly identified in segment IV of the liver, CHFC is typically asymptomatic and incidentally found on abdominal imaging. It is important to consider this entity in the differential diagnosis of atypical liver lesions since CHFC carries a risk of transformation into squamous cell carcinoma. A suspicion of CHFC is therefore an indication for surgical resection.Case presentationA 62-year-old male presented to surgery consultation for further evaluation of a hepatic cyst incidentally found on abdominal ultrasound. The patient was completely asymptomatic. Both abdominal computerized tomography and magnetic resonance imaging scan confirmed a 4 cm subcapsular cyst in segment IVa. Additional workup was unremarkable. Considering the diagnostic doubt the patient underwent laparoscopic cyst enucleation. Histology revealed a ciliated pseudostratified epithelium consistent with a CHFC.Clinical discussionCHFC is a rare diagnostic entity that should be considered in the differential diagnosis of cystic hepatic lesions, particularly those located in segment IV of the liver. Since it is frequently asymptomatic, CHFC is usually found incidentally during surgery or imaging studies. Diagnosis of CHFC preoperatively is difficult due to the lack of specific radiographic findings. Moreover, metaplasia and squamous carcinoma can occur. Therefore complete surgical excision is the recommended treatment.ConclusionDespite its rarity, CHFC carries a risk of malignant transformation. Accurate diagnosis is mandatory and surgical excision is recommended even in asymptomatic CHFC.

Comparison of the Effect on the Ovarian Reserve of Modern Methods of Treatment of Endometrioid Cysts

ObjectiveTo compare the efficacy and safety of autologous platelet-rich plasma (PRP) therapy in laparoscopy and transvaginal sclerotherapy for the treatment of endometrioid cysts for maintaining ovarian reserve. MethodsThe study included 71 women under age 35 years with primary and secondary infertility. Twenty women underwent sclerotherapy of endometrioid cysts followed by autologous PRP injection into ovarian tissue, and 21 underwent laparoscopic cyst removal by stripping followed by autologous PRP injection. The control group consisted of 30 women who underwent laparoscopic cystectomy by stripping without autologous PRP injection. We assessed ovarian reserve for all patients before surgery as well 3 and 6 months after surgery by measuring serum anti-Müllerian hormone (AMH) levels and calculating antral follicle count using ultrasound. ResultsIn the control group, AMH levels had decreased significantly at 3 and 6 months post-surgery, whereas levels in laparoscopy and PRP group remained almost unchanged from initial levels. In the sclerotherapy group, we observed a tendency towards increased AMH levels, but it was not statistically significant when compared with initial results. Follicle count changes were similar to AMH patterns. ConclusionIn this study, sclerotherapy in combination with PRP therapy for ovarian endometriomas was associated with improved measures of ovarian reserve, and the combination of laparoscopic excision of the endometrioma with PRP therapy facilitated ovarian reserve preservation.

Laparoscopic Management of Hepatic Hydatid Cyst at Bangabandhu Sheikh Mujib Medical University

Background: Laparoscopic management of hydatid cyst in the liver is now becoming popular with the introduction of modern devices like Pallanivelue Hydatid Cyst Cannula System that makes the procedure easier, safe, and acceptable. The laparoscopic approach is not only a cosmetic issue; it also prevents the recurrence rate by preventing spillage and complete removal of endocyst. Objective: Here we assess the Laparoscopic management of hydatid cyst in the liver of 30 cases at the Department of General Surgery. Methods: It is a prospective study having ages ranging from 18 to 65 years were included in this study, from April 2015 to March 2020. Laparoscopic endocystectomy was performed in all cases with deroofing of the cyst wall and observed the outcome of the procedure. All the cases were diagnosed clinically and confirmed by ultrasonography and CT scan. Results: A total of 30 patients, 13 males, and 17 were females. The most common presenting complaints were pain in the abdomen in 20(66.66 %), a lump in the right upper abdomen in 18(60 %), jaundice 2(10 %). Hepatic Hydatid cyst diagnosed by USG, CT scan, and serological test were included in this study. The distribution of cyst sizes was: 1-5 cm 3; 6-10 cm 8; 11-15 cm 10; &gt; 15 cm 9 patients. Abdominal ultrasound and CT scan were done to confirm the diagnosis of hepatic hydatid cyst in all patients. The right lobe was involved in 25(83.33 %), left lobe in 4(13.33 %) with both lobes in 1(3.33 %). Intraoperative complications 5(16.66%). Per operative bleeding 1(3.33%), spillage 2(6.66%), and cystic biliary communication 2(6.66%). The main operating time was 95(60-120) minutes. The mean duration of hospital stay was 5.22(3-10) days. Conclusion: The laparoscopic cyst evacuation and omentoplasty using PHS are safe for treating the hydatid cyst of the liver in the selected patients, while addressing all the conventional surgical principles of treating the hydatid cysts, like aspiration, prevention of spillage, sterilization of cysts, and partial deroofing. It aids early recovery with good cosmetic results. PHS is an ideal method for single or multiple hydatid cysts of the liver with minimal complications and morbidity.

One- versus two-stage single-incision laparoscopic cyst excision and hepaticojejunostomy in patients with completely perforated choledochal cysts and good medical conditions.

The aim of the current study was to evaluate the efficacy of one- and two-stage single-incision laparoscopic hepaticojejunostomy (SILH) for perforated CDCs with good medical conditions. Between June 2015 and December 2020, 57 patients were reviewed: Group 1: patients who underwent one-stage SILH (n = 16); Group 2: patients who underwent two-stage SILH (n = 41). The demographic characteristics, operational details, postoperative outcomes and postoperative complications were evaluated. The mean follow-up durations of group 1 and 2 were 39.3 and 38.6months, respectively. One patient (6.3%) in group 1, and 4 patients (9.8%) in group 2 were converted to laparotomy (p = 0.67). No statistical significance was found in operative time, blood transfusion, time to resume full diet, duration of drainage after definitive surgery and postoperative hospital stays between the two groups. Four patients in group 2 developed bile leakage, which was higher than that in group 1 (9.8% vs 0, p = 0.20). None suffered incidental injury, bleeding, anastomotic stenosis, cholangitis, cholelithiasis, pancreatic leakage, pancreatitis, Roux-loop obstruction, adhesive intestinal obstruction or wound infection. Liver function normalized within 1year postoperatively in both groups. In experienced hands, one-stage single-incision laparoscopic hepaticojejunostomy is safe and effective for patients with complete perforations and good medical conditions.

Sclerotherapy of Symptomatic Nonparasitic Splenic Cysts: Excellent Long-Term Treatment Response'

Abstract Background Splenic cysts are rare and occur in 0.5 to 2% of the population. They are usually asymptomatic and do not require therapy. In case of symptomatic nonparasitic splenic cysts, potential therapy includes partial splenectomy or laparoscopic cyst de-roofing as well as ultrasound-guided sclerotherapy with 1% polidocanol or 10% sodium chloride (NaCl) as an interventional alternative. So far, single-session sclerotherapy of symptomatic nonparasitic cysts is recommended only if clear-transparent cyst fluid is aspirated. Materials and Methods We report a case series of 17 patients with symptomatic macroscopically turbid nonparasitic splenic cyst fluid who underwent ultrasound-guided fine needle sclerotherapy with either polidocanol ± 10% NaCl (n = 12) or 10% NaCl alone (n = 5) and a follow-up of a maximum of 12 years after first intervention. Clinical, sonographic, and laboratory chemistry data were recorded at baseline and during the follow-up. Results The mean follow-up time was 43.65 ± 40.18 months. At the end of the follow-up, a 79% reduction of cyst size was achieved. The maximum size reduction in the polidocanol group was 76 ± 18% and 84 ± 21% in the sodium chloride group (p &gt;0.05). At the end of follow-up, 15 out of the 17 patients did not have any further symptoms. Despite the cystic fluid being turbid, it was hardly possible to detect a microbiological superinfection. Conclusion Sclerotherapy of splenic cysts leads to a significant size regression in all patients, independent of the sclerotherapy agent used with fewer systemic toxic side effects of polidocanol treatment. It was shown that in a tertiary care center with significant experience, sclerotherapy of splenic cysts is also safe and successful and can lead to a drastic regression of cyst size and symptoms. This shows that interventional therapy is a good alternative to surgical procedures.