Laparoscopic Drainage Research Articles

ASSESSMENT OF METHODS OF DIAGNOSIS AND TREATMENT OF PANCREATIC CYSTS

Abstract. The frequency of formation of pancreatic cysts in acute and chronic pancreatitis is 5-30%, and in destructive forms it increases to 60-70%. Persons of working age from 30 to 60 years old are mainly prone to the disease, which confirms the social significance of this problem. The aim: increase the effectiveness of surgical treatment of pancreatic cysts by using advanced diagnostics and methods of external and internal drainage. Materials and methods: the study is based on the analysis of the results of surgical treatment of patients with pancreatic cysts who were treated at VRCH n.a. M.I. Pirogov in the period from 01.01.2018 to 01.06.2024. A total of 65 patients were observed. The results: infection of the postoperative wound was observed in 6.15% of patients. 1.54% of patients developed adhesions, which were treated conservatively. The average time for removing drains with laparoscopic drainage is 21.2±1.5 days. There were no fatal consequences. Conclusions: the use of advanced diagnostics followed by differential selection of the treatment method significantly reduces the number of complications, reduces mortality and the length of stay of patients in the hospital.

Less Is (Sometimes) More: Laparoscopic Peritoneal Lavage and Drainage for Diverticulitis.

Introduction: Laparoscopic lavage and drainage (LLD) emerged as an alternative to Hartmann's procedure (HP) for patients with diverticulitis and uncontained perforation. Although initially popular as a less invasive approach, its use in modern practice is in question. This summary will review the available literature to show techniques, outcomes, and indications. Methods: The literature was reviewed for relevant case studies, randomized trials, prospective series, retrospective analyses, and meta-analyses to define peritoneal lavage and determine the clinical outcomes of peritoneal lavage. Results: LLD can be considered on an individual basis for Hinchey III diverticulitis (purulent peritonitis), but there are several contraindications. The extent of adhesionolysis (limited versus extensive) as well as the management of sites of perforation found during surgery are debated. Most surgeons continue lavage with warm saline until water runs clear and place drains in the operation. Three randomized controlled trials (RCTs), the LADIES, SCANDIV, and DILALA trials compared LLD with either resection and anastomosis or Hartmann's procedure. One other RCT (the LapLAND trial) is still with results pending. The LADIES trial studied LLD versus primary anastomosis and resection in Hinchey III diverticulitis and was terminated early secondary to higher 30-day morbidity in the LLD arm; however, 3-year data showed no significant difference in morbidity and mortality. The SCANDIV trial compared LLD with resection in acute diverticulitis (Hinchey I-III) and saw no difference in 90-day morbidity or mortality; however, it noted higher rates of reoperation in the LLD group. The DILALA trial compared Hinchey III diverticulitis patients undergoing LLD with open HP and found that the LLD group had a lower rate of reoperation at 2 years, but no difference in rates of readmission or mortality. Conclusions: Debate still remains over the technique of LLD and specific indications, as well as outcomes compared with resection and primary anastomosis or HP.

Case Report: A 31-Year-Old Man with Relapsing Complicated Diverticulitis after Initial Conservative Treatment

BACKGROUND: There is controversy regarding the surgical approach for severe complications of diverticular disease. The classical approach has been a Hartmann’s procedure, but laparoscopic lavage and drainage has been suggested as an alternative. We present a patient who initially responded to conservative management of complicated diverticulitis, but had a recurrence that was managed surgically. CASE PRESENTATION: A 31-year-old man presented with Hinchey Stage I diverticulitis and was discharged from the hospital after medical management. Six days later, he returned to the hospital with radiographic evidence of a pericolonic abscess. The patient was taken to the operating room for laparoscopic drainage with placement of a drain in the abscess cavity. He required reoperation with sigmoid colon resection, primary anastomosis, and diverting ileostomy. DISCUSSION: Despite requiring reoperation, the authors believe that initial conservative management possibly prevented progression to generalized feculent peritonitis. If this had occurred, the patient may have required Hartmann’s procedure, which is associated with more complications than primary anastomosis with protective ileostomy. CONCLUSION: The patient had recurrence of complicated diverticular disease that was initially managed conservatively and then with laparoscopic drainage, followed by primary anastomosis with protective ileostomy. Given individual patient factors, the authors believe that he was managed optimally. There is currently controversy between the use of laparoscopic lavage and drainage versus Hartmann’s procedure for the management of complicated colonic diverticular disease and more investigation is required on the subject.

Surgical treatment of localised pelvic lymphocyst infection after radiotherapy for endometrial cancer

Endometrial cancer is mainly treated clinically by surgery, supplemented by postoperative radiotherapy. Pelvic and abdominal lymph node dissection is usually an important part of surgery, and one of the most common postoperative complications is lymph node cysts. Infection of cysts is very rare in clinical practice and can be cured mainly by anti-infection and puncture drainage. However, in this case, the patient was found to have a pelvic abscess due to radiating pain in the left lower limb, and the infection of the local lymphocyst was found to have formed a pelvic abscess, and laparoscopic open drainage was performed after puncture drainage with no improvement in symptoms. The patient recovered after surgery.

ЛАПАРОСКОПИЧЕСКАЯ ПАНКРЕАТОЦИСТОЕЮНОСТОМИЯ

Background. Pancreatic pseudocyst formation is known to be one of the most common complications of chronic pancreatitis. Despite the widespread use of the laparoscopy, it is still relatively rarely employed in pancreatic surgery. Objective. To analyze the outcomes of laparoscopic Roux-en-Y pancreatocytojejunostomy as well as to present a brief literature review. Material and methods. Data from diagnostic examinations, laboratory tests, as well as the outcomes of surgical treatment of a female patient for a pancreatic cyst are presented. It is worth noting that a laparoscopic Roux-en-Y pancreatocystojejunostomy was used for pancreatic cyst treatment in this case. Results. Successfully performed laparoscopic surgery enabled to preserve as much of the pancreas as possible and to avoid postoperative complications. Conclusions. The described case, along with the reviewed publications, indicate that laparoscopic internal drainage may be regarded as a feasible method for the treatment of encapsulated cysts of the body and tail of the pancreas in chronic pancreatitis. This is due to the fact that this surgical option doesn’t involve pancreatic parenchyma volume reduction and has a lower risk of relapse as compared with external drainage methods. Based on the above mentioned, the choice of this method is associated with relatively minimal surgical trauma, fewer complications and a short-term postoperative period. To perform such operations successfully, special tools and skills are required. The presence of domestically produced endoscopic staplers contributes to the further implementation of this type of intervention into practice.

Unusual case of Niemeier type II gallbladder perforation: case report and literature review.

Niemeier type II gallbladder perforation (GBP) is caused by inflammation and necrosis of the gallbladder wall followed by bile spilling into the abdominal cavity after perforation. The gallbladder then becomes adhered to the surrounding inflammatory tissue to form a purulent envelope, which communicates with the gallbladder. At present, the clinical characteristics and treatment of type II GBP are not well understood and management of GBP remains controversial. Type II GBP with gastric outlet obstruction is rare and prone to misdiagnosis and delayed treatment. Recent systematic reviews report that percutaneous drainage does not influence outcomes. In this current case, due to the high risk of bleeding and accidental injury, as well as a lack of access to safely visualize the Calot's triangle, the patient could not undergo laparoscopic cholecystectomy, which would have been the ideal option. This current case report presents the use of percutaneous laparoscopic drainage combined with percutaneous transhepatic gallbladder drainage in a patient with type II GBP associated with gastric outlet obstruction. A review of the relevant literature has been provided in addition to a summary of the clinical manifestations and treatments for type II GBP.

OA17 An unusual cause of unilateral retroperitoneal fibrosis

Abstract Background/Aims Retroperitoneal fibrosis (RPF) is a rare condition, with an incidence of around 1 per 200,000 to 500,000 per year. It is distinguished by fibro-inflammatory changes in the retroperitoneum, which typically surrounds the abdominal aorta. Idiopathic RPF is common, whilst secondary causes can result from drug therapies, infection, malignancy, or surgery. Early symptoms include dull, poorly-localised back or flank pain, and lower limb swelling. The classical focal mass of primary retroperitoneal fibrosis is typically situated over the distal aorta, anterior to the L4 and L5 vertebra. External compression of the ureter can result in hydronephrosis due to prevention of normal ureteric urinary peristalsis. Management options are limited, generally involving immunosuppression and urological surgery, often necessitating cross-specialty, multidisciplinary input. Methods We report the case of a young gentleman with no past medical or family history who presented with abdominal pain, vomiting, septic shock and metabolic acidosis. To exclude acute abdominal pathology, computed tomography (CT) abdomen and pelvis was performed. Incidentally, this found chronic inflammatory changes in the descending colon and right retroperitoneal soft tissue thickening causing severe right hydroureteronephrosis. This incidental finding of retroperitoneal fibrosis on CT scan prompted an exploration into infective, inflammatory, and malignant aetiological causes of retroperitoneal fibrosis. Results Following initial stabilisation, urological opinion was sought, which concluded that surgical intervention for ureteric stenting was unnecessary. This decision was supported by the absence of obstruction from fibrosis and the lack of signs indicating infection. No medical explanation was found for the initial presentation in extremis. Rheumatological advice was sought for consideration of biopsy and immunosuppressive therapy for this suspected primary retroperitoneal fibrosis. Upon inquiry, the patient divulged a historical occurrence of retroperitoneal fluid accumulation secondary to a paravertebral mass that mandated laparoscopic drainage four years ago overseas. Histopathological analysis of the mass confirmed the presence of tuberculosis (TB), which was treated. His recovery was complicated at that time by right-sided hydronephrosis and fibrosis necessitating decompression. This sequence of events was deemed by a radiologist to also account for the observed bowel findings in the right flank. Conclusion This case report is the first of its kind to document TB, or any infective aetiology, as being the primary cause of unilateral retroperitoneal fibrosis. Unilateral retroperitoneal fibrosis is incredibly rare, and there are only four English language case reports in the literature. Idiopathic RPF typically presents as bilateral concentric tissue around the abdominal aorta, whilst secondary causes can lead to unconventional imaging patterns, as seen in this case. It was only upon direct inquiry that the patient disclosed a prior diagnosis of TB affecting the lumbar spine. This case highlights the importance of meticulous history taking and systematic exclusion of secondary causes of RPF, prior to contemplating invasive biopsies and steroid therapy. Disclosure D. Li: None. M. Renju: None.

Laparoscopic Appendectomy in the Treatment of Patients with Complicated Acute Appendicitis

Relevance Treatment of complicated forms of acute destructive appendicitis continues to be an urgent problem in emergency abdominal surgery. Aim of study Improving the results of surgical treatment of patients with appendiceal peritonitis with laparoscopic appendectomy.Material and methods A retrospective analysis of the treatment of 150 patients with acute appendicitis complicated by local and diffuse peritonitis aged from 17 to 69 years was carried out. There were 77 (51.3%) women and 73 (48.7%) men. Depending on the treatment tactics used, two groups of patients were divided. In the main group (64 patients), the leading treatment method was laparoscopic appendectomy. In the comparison group (86 patients), traditional approaches were used, including open appendectomy with the McBurney approach in 72 patients (83.7%) and laparotomy for diffuse peritonitis in 14 (16.4%).Results The analysis of the surgical techniques used showed that in the main group, wound postoperative complications developed in 9 patients (14.1%). In the comparison group, postoperative complications developed in 32 patients (37.2%). For local non­limited peritonitis, the total duration of hospitalization after laparoscopic appendectomy performed in 49 patients was 6.7±1.4 days, and 8.6±2.1 days (p<0.05) in 72 patients who underwent open appendectomy. The duration of hospitalization was 8.2±2.7 days in case of diffuse peritonitis after laparoscopic appendectomy, sanitation and drainage of the abdominal cavity (15 cases), and 12.4±1.3 days (p<0.05) in 14 patients after laparotomy, appendectomy, sanitation and drainage of the abdominal cavity, intubation of the small intestine.Conclusion Laparoscopic appendectomy may be the operation of choice for complicated forms of acute appendicitis according to developed indications. It should be performed by a surgeon experienced in endosurgical operations. To increase the efficiency of washing the abdominal cavity in case of diffuse peritonitis, it is recommended to use hardware sanitation. The capabilities of laparoscopic appendectomy make it possible to adequately perform the required amount of surgical treatment, minimize surgical trauma, and significantly reduce the rate of postoperative complications and the duration of hospital treatment compared to open appendectomy.

Laparoscopic necrosectomy for acute necrotising pancreatitis: Retrospective analysis of a decade-long experience from a tertiary centre.

The objective of this study is to evaluate the role of minimally invasive surgery for the management of necrotising pancreatitis in acute settings and to propose tailor-made approaches to deal with various locations of pancreatic necrosis. Three hundred and thirteen patients underwent laparoscopic management of necrotising pancreatitis in this study period from January 2010 to June 2021, out of which 122 patients underwent minimally invasive necrosectomy for acute necrotising pancreatitis. The remaining 191 patients underwent laparoscopic internal drainage in the form of cystogastrostomy/cystojejunostomy for walled-off pancreatic necrosis. Mean body mass index was 26.45 ± 3.78 kg/sqm. Mean operating time was 56.40 ± 20.48 min and mean blood loss was 120 ± 31.45 mL. Ten patients required reoperation (6 underwent open procedure and 4 underwent laparoscopic redo necrosectomy). Six patients died of multi-organ failure. The mean duration of return of bowel function was 5 ± 1.8 days. The mean length of hospital stay after surgery was 10.19 ± 7.09 days. There were no major wound-related complications. A minimally invasive approach to pancreatic necrosectomy is safe and feasible with good outcomes in centres with advanced laparoscopic expertise. It requires not only careful case selection but also proper timing and the ideal route of access to achieve optimal outcomes.

Laparoscopic drainage versus interventional radiology for management of appendicular abscess: a randomized controlled trial

Background Laparoscopic drainage of appendicular abscess has become a novel technique due to its advantages over interventional radiology like a complete exploration of the abdomen, exclusion of other pathologies, excision of the appendix at the same session, better cosmesis, decreased incidence of wound infection, better visualization of surgical field, fine handling of edematous tissue and drainage of multiple collections. Patients and methods This randomized controlled clinical trial included all patients who developed the manifestations of appendicular abscess and were referred to the Zagazig University Hospital Emergency Department between January 2020 and February 2022. The study was prospectively approved by the Zagazig University Faculty of Medicine Institutional Review Board (Approval Number: 9871/26-9-2022), and was retrospectively submitted to clinicaltrials.gov in June 2022 (ClinicalTrials.gov ID: NCT05419440). The sample size was 172 patients divided into two equal groups, a laparoscopic group involved 86 patients (group 1) and an interventional radiology group involved 86 patients (group 2). Results Group 1 (laparoscopic drainage group) included 86 patients: 55.8% were males, with a mean age of 41.2 SD 12.2 years-old, while group 2 (interventional radiology group) included 86 patients: 51.2% were males, with a mean age of 36.8 SD 10.9 years-old. The incidence of reported complications in group (1) was 1 (1.2%) for bowel injury, 3 (3.5%) for fecal fistula, 0 (0%) for recurrence, 0 (0%) for pelvic collection and 0 (0%) for mortality while in group (2) were 5 (5.8%) for bowel injury, 0 (0%) for fecal fistula, 3 (3.5%) for recurrence, 8 (9.3%) for pelvic collection and 1 (1.2%). The incidence rates of quality of life in group (1) were 48 (55.8%) for excellent quality of life, 38 (44.2%) for good quality of life and 0 (0%) for poor quality of life, unlike group (2), the incidence rates of quality of life were 12 (14%) for excellent quality of life, 59 (68.6%) for good quality of life and 15 (17.4%) for poor quality of life. Conclusion Laparoscopic management of appendicular abscess was safely applied in a good experienced hand without the need for interval appendectomy.

Liver Abscess Secondary to Acute Perforated Cholecystitis: Case Report and Literature Review

Pyogenic liver abscess is a rare clinical entity, having a reported incidence of 1.1/100,000 to 3.6/100,000 people in western countries, and with a reported mortality between 5.6-10%, however, this mortality can increase up to 22% if there are multiple abscesses. The prevalence of acute cholecystitis is reported at 0.8-3.8%; Only 2% of all patients with cholelithiasis will present a gallbladder perforation, and the reported mortality in these cases has been reported between 12 to 16%. The most common site of perforation is the gallbladder fundus because it is the most distal portion, which leads to having less blood flow. Its clinical presentation is not specific, and the ultrasound is usually the first imaging tool for diagnosis. Treatment will depend on the clinical condition of each patient. Here we present an 88-year-old female case successfully treated with laparoscopic cholecystectomy and liver abscess drainage despite hemodynamic instabilityPyogenic liver abscess is a rare clinical entity, having a reported incidence of 1.1/100,000 to 3.6/100,000 people in western countries, and with a reported mortality between 5.6-10%, however, this mortality can increase up to 22% if there are multiple abscesses. The prevalence of acute cholecystitis is reported at 0.8-3.8%; Only 2% of all patients with cholelithiasis will present a gallbladder perforation, and the reported mortality in these cases has been reported between 12 to 16%. The most common site of perforation is the gallbladder fundus because it is the most distal portion, which leads to having less blood flow. Its clinical presentation is not specific, and the ultrasound is usually the first imaging tool for diagnosis. Treatment will depend on the clinical condition of each patient. Here we present an 88-year-old female case successfully treated with laparoscopic cholecystectomy and liver abscess drainage despite hemodynamic instability.

Management of idiopathic chylous peritonitis during laparoscopy: a case report and review of literature

Chylous ascites is rare. Etiology can be traumatic, atraumatic or idiopathic. We present a case of idiopathic peritonitis managed by laparoscopic drainage and a medium-chain triglyceride diet. We present a case of a 60-year-old white female who presented to the emergency department with diffused abdominal pain, migrated from the back, and clinical signs of peritonitis. Blood works showed high leukocytosis, and computed tomography showed a large amount of intraperitoneal and retroperitoneal fluid. During an emergency laparoscopy, a chylous ascites was seen and drained, but a causing factor was not identified intraoperatively. Postoperatively, medium-chain triglyceride diet was initiated for a period of 6 weeks, cytological, microbiological and chemical analysis showed elevated levels of triglycerides in absence of other disease. Multiple diagnostic tests revealed no malignancy nor another underlying pathological processes. patient recovered well with no complications. When confronted with chylous ascites, surgeons should drain the abdomen and do thorough evaluation. When no cause is found intraoperatively, surgeons should not take aggressive measures but instead initiate a medium-chain triglyceride diet and search for underlying causes by means of further laboratory testing and positron emission tomography combined with computed tomography (PET-CT). When no etiology is found, medium-chain triglyceride diet can be stopped with no reports of recurrence.

Laparoscopic deroofing of a recurrent giant simple hepatic cyst in a geriatric female: Case report.

Liver cysts often have no symptoms, are benign and are usually encountered during routine abdominal imaging for other conditions. Giant cysts have a higher risk of complications. Recurrence is common, and most research papers support laparoscopic deroofing as the initial management modality even in the recurrent cases as it avoids the morbidity of laparotomy and gives better short- and long-term post-operative outcomes. Here, we present a case of a 68-year-old female who presented to the outpatient department with complaints of right-sided dull-aching abdominal pain, heaviness, early satiety and significant weight loss for the past 2 months. A laparoscopic drainage and deroofing were done, and histopathological examination of the cystic wall was consistent with benign pathology. The patient has been doing well for the past year.

Study of laparoscopic drainage of liver abscess

Background: Open surgical drainage was the initial treatment method for liver abscess until 1980s when image guided percutaneous aspiration in combination with antibiotic therapy became the standard of care, although open surgical drainage of liver abscess becomes necessary in some cases. Laparoscopic drainage can be considered as an alternative to surgical drainage as it reduces the morbidity and mortality and improves recovery when other treatment modalities fail. The current study is undertaken to assess the efficacy in short & long-term considering the complications, morbidity & mortality. Methods: In this study, we will describe the procedure and clinical outcome of laparoscopy guided drainage of liver abscess. Results: 38 cases with liver abscess were treated by laparoscopic drainage. Mean age in the study was 42 years. Mean operating time was 88 minutes. Laparoscopic drainage was uneventful in majority (78.94%). Conversion to open surgery was noted in 6 patients. No postoperative mortality was noted. Conclusions: Laparoscopic drainage of large liver abscess is a safe treatment option. Rapid drainage & early recovery are the well-known advantages, although some limitations will require conversion for safety of the patient.

#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.

Laparoscopic drainage basin hepatectomy based on cone unit

Laparoscopic drainage basin hepatectomy based on cone unit

Obstructed Hemi-Vagina with Ipsilateral Renal Agenesis Syndrome in Adulthood: A Diagnostic Challenge.

A patient in her early 20s presented with constant and progressive lower abdominal and back pain, mainly on the right side of the abdomen, purulent vaginal discharge and pyrexia. A radiological assessment revealed a possible tubo-ovarian abscess and the incidental diagnosis of ipsilateral renal agenesis. The patient was treated for pelvic inflammatory disease (PID); however, after antibiotic administration and since the symptoms did not resolve, an abdominal MRI was requested, which revealed uterus didelphys with two cervices, an obstructed haemivagina and evidence of haematocolpos. The diagnosis of Obstructed Hemi-Vagina with Ipsilateral Renal Agenesis (OHVIRA) syndrome was confirmed, and the patient underwent the excision of the vaginal septum, the drainage of the haematopyocolpos and the laparoscopic drainage of the tubo-ovarian abscess. She achieved a good recovery.

Successful Thoracoscopic Excision of Left Middle Mediastinal Teratoma in a Girl

We wish to present a very unusual case of a toddler girl who presented with acute abdomen and features of peritonitis. Inflammatory markers were high but tumor markers were all within normal limits. The plain abdominal radiograph indicated suspicious small free air under the dome of diaphragm. Chest radiograph in standing position confirmed the suspicion but incidentally showed a well-defined soft tissue mass in the mediastinum over left hilar region. Contrast enhanced computed tomography of chest, abdomen and pelvis confirmed mature left mediastinal teratoma and appendicular abscess. The patient underwent laparoscopic drainage of appendicular abscess and appendicectomy and was discharged home after 6 days. An elective thoracoscopic resection of left mediastinal teratoma was performed uneventfully. The patient is asymptomatic with normal tumor markers and chest radiograph at 10 years follow up.

A case of one‐stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury associated with infected urinoma

IntroductionIatrogenic ureteral injury is a rare but often encountered complication of abdominal and gynecological surgery. This is a case of iatrogenic ureteral injury with infected urinoma treated with one‐stage laparoscopic drainage and ureterocystoneostomy.Case presentationAn 80‐year‐old man with rectal cancer had robot‐assisted low anterior rectum resection and left lateral lymph node dissection after colostomy and preoperative chemoradiotherapy. On the 14th postoperative day, he had a fever, and a noncontrast‐enhanced computed tomography scan revealed a low‐density polycystic area in the left pelvic cavity. Retrograde pyelography revealed contrast medium leaking from the left lower ureter, preventing ureteral stent placement. We identified it as a delayed ureteral injury with infected urinoma and performed laparoscopic one‐stage drainage and ureterocystoneostomy.ConclusionThis study reported a case of one‐stage laparoscopic drainage and ureterocystoneostomy for iatrogenic ureteral injury with infected urinoma.

The Short- and Long-Term Safety and Efficacy Profile of Subtotal Cholecystectomy: A Single-Centre, Long-Term, Follow-Up Study.

Background Subtotal cholecystectomy (STC) has been reported as an effective method to remove the gallbladder if the hepatocystic triangle anatomy is unfavourable. However, the evidence regarding its long-term outcomes from the United Kingdom (UK) is lacking. This study aimed to assess its short and long-term outcomes with a minimum of one-year follow-up. Methodology We retrospectively analysed all elective and emergency STCs performed in a single UK NHS Trust between 2014 and 2020. Relevant data were collected using electronic patient records and questionnaire-based, long-term, telephonic follow-up (median follow-up of 3.7 years). Outcomes examined were immediate/short-term complications (biliary injury, bile leak, return-to-theatre) and long-term problems (recurrent symptoms, choledocholithiasis, cholangitis/pancreatitis). Results There were a total of 50 STC cases (58% females) out of 4,341 cholecystectomies performed (1.15%), with the median age, body mass index, and length of stay being 69.5 years, 29 kg/m2 and eight days, respectively. Twenty-eight (56%) were emergency. No patient endured bile duct injury. Seven (14%) patients had postoperative bile leak which was significantly more common when Hartmann's pouch was left open (33% vs. 8%; p = 0.03). No bile duct injury was reported. Most were managed conservatively (endoscopic retrograde cholangiopancreatography + stent: four; radiological drainage: one; no intervention: one). Only one patient required laparoscopic lavage and drainage. The true incidence of developing choledocholithiasis over the long term was 4/50 (8%) in our study. The median interval between STC and the diagnosis of postoperative choledocholithiasis was 15.9 months. All four patients had undergone type 1 STC (where the remnant of Hartmann's pouch was closed with sutures); however, subsequent cross-sectional imaging (magnetic resonance cholangiopancreatography or computed tomography) showed that the gallbladder remnant was visible in only two of these four patients. Conclusions STC is a safe option in difficult situations and prevents bile duct injury. Although the risk of bile leak can be reduced by closing Hartmann's pouch remnant, this may slightly increase the risk of subsequent stone formation. Infrequent occurrence of recurrent gallstone-related symptoms or complications favours its use.