Laparoscopic Ileocecal Resection Research Articles

A case of MCA arising from ICA: a case report.

Complete mesocolic excision (CME) and central vascular detachment are very important procedures in surgery for colorectal cancer. Preoperative and intraoperative assessments of the anatomy of major colorectal vessels are necessary to avoid massive bleeding, especially in endoscopic surgery. A case with a rare anomaly in which the middle colic artery (MCA) and ileocolic artery (ICA) had a common trunk is reported. The patient was a 73-year-old woman diagnosed with ascending colon cancer on colonoscopy. Preoperative abdominal contrast-enhanced computed tomography confirmed that the MCA and ICA had a common trunk. She underwent laparoscopic ileocecal resection for the ascending colon cancer with D3 lymph node dissection. Intraoperative indocyanine green fluorescence imaging was conducted. After confirming vessel bifurcation, the ICA was dissected at the distal end of the MCA bifurcation. The patient has been followed as an outpatient, with no signs of recurrence as of 2 years postoperatively. A case of an ascending colon cancer with a unique vascular bifurcation pattern was presented. Preoperative and intraoperative evaluations of the major colorectal vessels are very important for preventing perioperative and postoperative complications.

P044 Evaluation of the CO2 Footprint of Laparoscopic Ileocecal Resection for Terminal Ileitis in Crohn's Disease

Abstract Background Each year, huge amounts of carbon dioxide (CO2/equivalents) are generated and healthcare systems play a major role in the production of those so called greenhouse gases (GHG). The aim of this study is to assess the environmental impact, in particular the CO2 footprint, of laparoscopic ileocecal resection (ICR) for terminal ileitis in Crohn’s disease (CD) patients. Methods This is a prospective, multicentre evaluation of the carbon dioxide (CO2) emission caused by the care of CD patients undergoing laparoscopic ICR for terminal ileitis. All processes and products used during laparoscopic ICR for terminal ileitis in adult CD patients (≥16 years) between March and May 2023 were collected by one monitor. A Life Cycle Assessment (LCA) was conducted, including midpoint and endpoint analysis, to evaluate and compare the environmental impact, mainly focussing on CO2 (-equivalents), of all products and processes. Results The total CO2 footprint of a laparoscopic ICR for terminal ileitis in one CD patient (including transport of staff and patients) was 139 kg CO2eq, which equals a one way trip by car from Amsterdam to Berlin. Major contributors to CO2 emissions (“hotspots”) were transport of employees, transport of patients, medication, laparoscopic tools, electricity in theatre and a combination of standard surgery items. In addition to the carbon footprint, a significant impact on ozone formation, human carcinogenic and ecotoxicity, water consumption and mineral resource scarcity was found. The amount of disability-adjusted life years (DALY’s) as a result of the environmental impact of one laparoscopic ICR are equal to approximately 2.5 hours of health damage per laparoscopic ICR. Conclusion The “5 R principle” (refuse, reduce, reuse, repurpose, recycle) is an import aspect in reduction of the CO2 footprint and in current medical guidelines, which should be taken into account by all employees (e.g. consider traveling by train/carpooling). The total CO2 footprint of a laparoscopic ICR for terminal ileitis in one CD patient is 139 kg CO2eq. In addition to quality of life (QoL) and overall costs, the carbon footprint and overall the environmental impact of all medical procedures, should be taken into consideration and should be optimized if possible in the multimodal treatment of patients with CD terminal ileitis. Therefore, further research into the environmental impact of (medical/surgical) treatment of CD patients is warranted and more process data should become available.

Duplication of the appendix masquerading as appendiceal tumor: a case report

BackgroundThis case report highlights the exceptional rarity of appendix duplication in adults, a condition that closely mimics appendiceal tumors, posing diagnostic challenges. The novelty of this case lies in its presentation of a Type A duplication, emphasizing the diagnostic intricacies involved in distinguishing it from other pathologies.Case presentationWe present the case of a 69-year-old male with a history of hypertension, hyperuricemia, and duodenal gastric ulcer, who presented with a positive occult blood test. Lower gastrointestinal endoscopy revealed an appendiceal orifice with atypical hyperemia and edema. Subsequent imaging and biopsy results suggested an appendiceal tumor, prompting laparoscopic ileocecal resection. Intraoperative findings revealed an unremarkable appendix, but histopathological analysis unveiled appendiceal duplication, characterized by bifurcation into two lumens within a thick serosal wall. The patient was discharged without complications.ConclusionsThis case underscores the importance of recognizing appendix duplication as a rare differential diagnosis for appendiceal tumors. Surgeons should remain vigilant, especially in cases of Type A duplication, where preoperative diagnosis remains challenging. Early identification can avert potential complications and missed congenital anomalies.

A rare case of esophageal metastasis from signet-ring cell carcinoma of the cecum

BackgroundMetastatic esophageal cancer is rare. Its common primary lesions include lung cancer and breast cancer. Metastatic esophageal cancer originating from colorectal cancer is rarer.Case presentationA 79-year-old woman visited our hospital because of lower abdominal discomfort. She was endoscopically diagnosed with type 0–IIa + IIc cancer of the cecum, and biopsy of the lesion showed signet-ring cell carcinoma. With a preoperative clinical staging of cStage I (cT2, cN0, cM0), the patient underwent laparoscopic ileocecal resection with D3 lymphadenectomy. Histopathological examination of the resected specimens revealed signet-ring cell carcinoma [type 4, pT4a, pN3 (No. 203), M0, pRM1, stage IIIc, R1]. Despite radial margin positivity, the patient refused resection of the residual tumor and received oral tegafur and uracil. KRAS mutation test showed KRAS wild-type colon cancer, but she refused anti-epidermal growth factor receptor therapy. One year after surgery, her blood carcinoembryonic antigen concentration elevated. Colonoscopy showed anastomotic recurrence and biopsy of the lesion showed signet-ring cell carcinoma. Upper gastrointestinal endoscopy showed multiple longitudinal submucosal tumors with erosions on their surfaces in the esophagus. Tumor biopsy revealed signet-ring cell carcinoma. Immunohistochemistry showed that the histological type of the esophageal tumors was the same as that of the primary colon cancer. Based on these findings, the esophageal tumors were diagnosed with metastasis from signet-ring cell carcinoma of the cecum. The oral chemotherapy was replaced with FOLFOX plus bevacizumab. However, the patient’s condition required treatment discontinuation, and she died of cancer progression 1 year and 5 months after surgery.ConclusionsTo our knowledge, this is the first case report on metastatic esophageal cancer from signet-ring cell carcinoma of the cecum. Esophagoscopy showed multiple longitudinal submucosal tumors, which is similar to an endoscopic finding of intramural metastasis from primary esophageal cancer. We consider that the multiple longitudinal submucosal tumors are a notable feature of our case. When metastatic esophageal cancer is suspected, clinicians, endoscopists, and pathologists should consider signet-ring cell carcinoma of the colon as one of potential primary lesions. This consideration could lead the specialists to appropriate examinations and treatments, thereby improving clinical outcomes in patients with the metastasis.

A Case of Iliac Adenomyoma with Repeated Intestinal Obstruction Treated with Laparoscopic Ileocecal Resection

A Case of Iliac Adenomyoma with Repeated Intestinal Obstruction Treated with Laparoscopic Ileocecal Resection

Goblet cell adenocarcinoma of the appendix: A case report of three cases

Introduction and importanceAppendiceal goblet cell adenocarcinoma is in 0.3–0.9 % of appendectomy specimens. There is still controversy regarding whether surgery with dissection or additional resection is necessary for goblet cell adenocarcinoma and whether adjuvant chemotherapy is practical. We present three cases of goblet cell adenocarcinomas. Case presentationCase 1: A 30-year-old woman was diagnosed with appendicitis and underwent appendicectomy. Histopathological evaluation revealed a malignant neoplasm with goblet-like cells and tumour infiltration into the subserosa. The patient underwent laparoscopic ileocecal resection, and the main lymph nodes at the root of the feeding vessels were removed. Case 2: A 50-year-old man was diagnosed with appendicitis and underwent appendicectomy. Histopathological evaluation revealed a malignant neoplasm with goblet-like cells; malignant cells were found at the surgical resection margins. The patient underwent laparoscopic ileocolic resection. Case 3: A 60-year-old man undergoing treatment for malignant melanoma. He was diagnosed with appendicitis associated with an appendiceal tumour, and emergency laparoscopic caecal resection was performed and diagnosed as goblet cell adenocarcinoma. We decided to prioritize treatment for malignant melanoma, and the patient is under follow-up for goblet cell adenocarcinoma and no metastasis was detected. Clinical discussionWe performed additional resection in two case of goblet cell adenocarcinoma. Diagnosing appendiceal goblet cell adenocarcinoma is difficult, and the prognosis of patients with positive lymph nodes is poor. Surgical treatment should be considered for the advanced stages of this disease. ConclusionGoblet cell adenocarcinoma, diagnosed after appendectomy, additional resection including lymph node dissection may provide a long-term prognosis.

Single-incision laparoscopic surgery for intestinal intussusception due to neuroendocrine tumor

BackgroundSmall intestinal neuroendocrine tumor (NET) is uncommon, but intestinal intussusception caused by NET is even rare. We report a rare case of single-incision laparoscopic surgery (SILS) for intestinal intussusception due to NET G1.Case presentationA 72-year-old woman presented with vomiting, diarrhea, and abdominal pain. Contrast-enhanced computed tomography (CT) revealed the target sign in the ascending colon. An enhanced nodule was detected at the lead point, leading us to suspect a tumor. Colonoscopy showed a tumor at the lead point of the intestinal intussusception. Histological findings led to a diagnosis of NET G1. Single-incision laparoscopic ileocecal resection with regional lymphadenectomy was then performed. The patient was discharged 10 days postoperatively with no complications.ConclusionWe achieved SILS with regional lymphadenectomy for preoperatively diagnosed intestinal intussusception due to NET G1. Although this condition is rare, surgeons should take this possibility into consideration in cases showing similar findings.

P371 Assessment Of Postoperative Complications Following Ileocecal Resection In Crohn’s Disease From A Low-To-Middle Income Country

Abstract Background Our study aims to assess risk factors of postoperative complications following ileocecal resection of Crohn’s disease from a low-to-middle income country perspective. We aimed to provide local data demonstrative of inner conditions and challenges. Methods This was a retrospective study conducted in a referral colorectal center in a low-to-middle income country from 2014 to 2020. We included all patients with Crohn’s disease admitted to our department for ileocecal resection. Patient’s and Crohn’s disease, surgical and postoperative characteristics were collected using chart review. We excluded all patients with missing data. We defined perioperative hemorrhage as blood loss≥200cc. Our primary outcome was immediate<90-days post-operative complications risk factors assessment. Results We included 83 patients with complete data. The median age was 34(18-75) and 54.2%(n=45) were female. Patients were 94.6%from urban areas and 5.4%(n=4) rural. Among all included surgeries, 83.1%(n=69) were elective and 16.9%(n=14) were emergency cases. Open surgery was conducted in 46 cases(55.4%), 30patients had laparoscopic ileocecal resection (36.1%), and 7(8.4%) had conversion. Immediate postoperative complications were reported in 16.9%(n=14);anastomotic leak 2(2.4%), surgical site infection 8(9.6%), entero-cutaneous fistula 2(2.4%), and postoperative hemorrhage 2(2.4%). Long-term outcomes with surgical reoperation were conducted in 5 cases(5.8%) excluding stoma removal. The total length of stay median was 6 days (4-31). Immediate postoperative complications were associated with postoperative bleeding(OR=27.8; 95% CI[1.26-614];p=0.001,Fisher’s=0.027), required transfusion during surgery or at postoperative follow-up(OR=18.3;95% CI[3.09-109];p<0.001,Fisher’s=0.001), hospital length of stay(t-test<0.001), pre-operative hemoglobin(t-test0.031). Conclusion Considering the accessibility of hemoglobin management in a low-to-middle income country, it represents an impactful tool in surgical quality enhancement.

LAPAROSCOPIC ILEOCECAL RESECTION OF CROHN'S DISEASE: THE EXPERIENCE OF THE MOSCOW CLINICAL RESEARCH CENTER

Background: the most common surgical intervention for complicated forms of Crohn's disease is ileocecal resection. This operation is performed in a planned manner with the ineffectiveness of conservative therapy. Also, the operation is performed according to emergency indications with the development of intestinal obstruction or septic complications. In the vast majority of cases, it is possible to perform a laparoscopic approach, thereby reducing the risks of complications and accelerating the recovery of the patient in the postoperative period.Aim: evaluation of the results of laparoscopic ileocecal resection in patients with Crohn's diseaseMaterials and methods: the study included 46 patients (21 women, 25 men) who underwent laparoscopic ileocecal resection for the stricture form of Crohn's disease. 18 patients were operated on for emergency indications, 28 – for planned indications. The mean age was 37.6 year.Results: conversion to laparotomy was performed in 4 patients (8.7%). The mean operative time was 128.2 minutes. Complications that required reoperation were in 3 patients (6.5%). 4 patients (8.7%) had purulent-septic wound complications.Conclusion: laparoscopic ileocecal resection for stricture Crohn's disease is a simple, easily reproducible operation, both in planned surgical interventions and in emergency cases.

Predictors of surgical intervention in the onset of stenotic Crohn’s disease in a 15-year-old teenager

Aim: to demonstrate a child with early ileocecal resection in stenosing Crohn’s disease, taking into account the risk factors of surgical intervention. Crohn’s disease (CD) is a chronic recurrent segmental granulomatous lesion of any part of the gastrointestinal tract, with a wide range of manifestations and various phenotypes of the disease. Despite the great diagnostic and therapeutic possibilities today, there is an increase in primary and secondary resistance to therapy, largely associated with an incorrect assessment of the CD phenotype, patient management strategy. In the above observation of CD in a teenager, clinical signs of ileocecal stenosis were observed 3 months after the supposed onset of the disease, which caused a planned laparoscopic ileocecal resection with the formation of a ileo-colon anastomosis. The start of CD in adolescence, positive ASCA-status are regarded as risk factors for surgical intervention in this child. Timely diagnosis did not allow to avoid surgery. It is necessary to make individual algorithms for the management of a child with CD, taking into account the predictors of surgical intervention, complications and unfavorable course of the disease already at the time of diagnosis.

7360 Surgical Management of Ileocecal Endometriosis, 6 Cases Treated with Laparoscopic Ileocecal Resection

<h3>Study Objective</h3> To present and discuss clinical features of ileocecal endometriosis (ICE) and feasibility of laparoscopic surgery for ICE. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Gynecology and Obstetrics department of a general hospital. <h3>Patients or Participants</h3> All patients who underwent laparoscopic surgery for ICE. <h3>Interventions</h3> Between December 2010 and January 2021, 6 patients underwent laparoscopic ileocecal resection for ICE. <h3>Measurements and Main Results</h3> A total of 6 patients (median age 37.0) underwent laparoscopic ileocecal resection. Five of the six cases had preoperative symptoms from ileocecal lesions such as bowel obstruction and abdominal pain. Three cases were diagnosed with ileal stenosis by contrast X-ray with nasointestinal tubes, and the other three were diagnosed with ICE by colonoscopy or double contrast barium enema (DCBE). All 6 patients had concomitant rectal endometriosis and underwent simultaneous laparoscopic lower anterior resection. In one case, ureteral stent placement was required for ureteral injury, and in one case, intestinal obstruction occurred postoperatively, but both cases improved without sequel. Postoperative hormone therapy with dienogest was performed in five patients. One patient underwent bilateral adnexectomy. No recurrence was observed in all patients (the median observation time: 48 month). <h3>Conclusion</h3> All patients with ileocecal endometriosis had rectal endometriosis and required two segmental intestinal resections. Laparoscopic surgery for ICE needs deep understanding of the gastrointestinal tract and advanced techniques of laparoscopic surgery, as well as cooperation with surgeons.

Signet-ring cell carcinoma of the appendix with ganglioneuromatosis: a case report

BackgroundPrimary cancer of the appendix, especially signet-ring cell carcinoma, is an uncommon disease, and it is rarely suspected before surgery. Diffuse intestinal ganglioneuromatosis that is not associated with neurofibromatosis-1 or multiple endocrine neoplasia 2b is also rare. The most frequent symptoms caused by it are changes in bowel habits, abdominal pain, and occlusive episodes.Case presentationThe patient was a 48-year-old woman who had a month-long history of chronic abdominal pain, fullness, constipation, and diarrhoea. Enhanced computed tomography showed a 100-mm irregular swelling in the appendix and thickening of the appendiceal wall with cystic dilatation. Based on a preoperative diagnosis of appendiceal cancer, the patient underwent laparoscopic ileocecal resection with D3 lymph node dissection. Pathological diagnosis revealed a signet-ring cell carcinoma of the appendix with ganglioneuromatosis. The patient completed four courses of capecitabine plus oxaliplatin (CAPEOX) as postoperative adjuvant chemotherapy, and 23-month postoperative outcome was noneventful without recurrence.ConclusionWe report a signet-ring cell carcinoma of the appendix that was detected early because of its presence with ganglioneuromatosis.

A case of diverticulum of the appendiceal base resembling a submucosal tumor of the cecum under colonoscopy: a hitherto undescribed lesion

BackgroundDiverticulosis of the appendix is an uncommon clinical entity, and a preoperative diagnosis is often difficult. Herein we report an unusual case of appendiceal diverticulosis.Case presentationA 72-year-old male was referred to our hospital to examine the cause of hematochezia. A colonoscopy study showed a protruding lesion resembling a submucosal tumor (SMT), approximately 20 mm in diameter, at the site around the appendiceal orifice of the cecum. An abdominal computed tomography and magnetic resonance imaging showed a cystic lesion at the appendiceal base. The lesion was clinically diagnosed as a cystic tumor of the appendix, but the possibility of a malignant tumor could not be excluded. Therefore, a laparoscopic ileocecal resection with lymph node dissection was performed. The pathological examination of the resected specimen revealed that the lesion was a diverticulum (pseudodiverticulum) occurring solitarily at the appendiceal base, in which the mucosal layer of the appendix was invaginated into the submucosa of the adjacent cecum, thus forming an SMT-like lesion.ConclusionTo our knowledge, this is the first case report in the English literature showing that an appendiceal diverticulum can manifest as an SMT-like lesion in the cecum. This condition should be recognized as a differential diagnosis for such lesions.

C-reactive protein monitoring after ileocecal resection and stoma closure reduces length of hospital stay: a prospective case-matched study in 410 patients with Crohn's disease.

The aim of this study was to evaluate a C-reactive protein (CRP)-driven monitoring discharge strategy for patients with Crohn's disease (CD) undergoing laparoscopic ileo-cecal resection (ICR) and if needed, temporary stoma closure (SC). Four hundred and ten patients who underwent laparoscopic ICR for CD: 153 patients (CRP group) between June 2016 and June 2020 at our department, had a CRP-driven monitoring discharge on postoperative day (POD) 3 and were discharged on POD 4 if CRP < 100mg/L. These patients were matched (according to age, sex, body mass index, type of CD (and stoma or not) to 257 patients who underwent laparoscopic ICR for CD between January 2009 and May 2016, without CRP monitoring (Control group). For SC, 79 patients with CRP monitoring were matched with 88 control patients. Primary outcome was overall length of hospital stay (LHS). Secondary outcomes were discharge on POD 4 for SC and POD 4 and POD 6 for ICR, 3-month postoperative overall morbidity and severe morbidity rates, surgical site infection, readmission rates, and CRP level in cases of morbidity at 3months. For ICR without stoma, mean LHS was significantly shorter in the CRP group than in the control group (6.9 ± 2days vs 8.3 ± 6days, p = 0.017). Discharge occurred on POD 6 (or before) in 73% of the patients (CRP group) vs 60% (Control group) (p = 0.027). For ICR with stoma, LHS was 8days for both groups (p = 0.612). For SC, LHS was significantly shorter in the CRP group than in the control group (5.5 ± 3days vs 7.1 ± 4days; p = 0.002). Discharge occurred on POD 4 in 62% (CRP group) vs 30% (Control) (p = 0.003). Postoperative 3-month overall and severe morbidity, and rehospitalization rates were similar between groups. CRP-driven monitoring discharge strategy after laparoscopic ICR for CD is associated with a significant reduction of LHS, without increasing morbidity, reoperation or rehospitalisation rates.

A Case of Internal Hernia after Laparoscopic Ileocecal Resection

症例は79歳女性．盲腸癌に対して腹腔鏡補助下回盲部切除を施行され，術後10ヵ月目に腸閉塞で緊急入院となった．CTにて浮腫状変化を伴った回腸の拡張，closed loop sign，少量の腹水を認め絞扼性腸閉塞を疑い緊急手術を行った．術中所見で，前回手術の腸間膜欠損部に回腸が嵌入する内ヘルニアによる腸閉塞と診断した．嵌頓した回腸を用手的に整復し狭窄を解除した後，4cmの腸間膜欠損部を縫合閉鎖した．術後合併症を認めず，第53病日に自宅退院となった．腹腔鏡下大腸切除における腸間膜欠損部が原因の内ヘルニアはまれな合併症の1つである．初回手術において腸間膜欠損部の閉鎖を全例に行う意義は少ないと考えられるが，本症例のように吻合部背側に立体的な空間が生じ，欠損部と後腹膜との癒着が不十分となることが予想される場合は，内ヘルニアに対する予防対策をとるべきと考えられた．

A rare case of synchronous appendiceal and cecal cancer

Primary appendiceal cancer is rare, and difficult to diagnose pre-operatively because lack of specific symptoms. This report presents a rare case of synchronous colon and appendiceal cancer. A 50-year-old man was referred to our hospital due to endoscopic submucosal resection (ESD) for early cecal cancer. ESD was performed, and the pathological examination revealed tubular adenocarcinoma with deep submucosal invasion. Laparoscopic ileocecal resection was performed as additional resection after ESD of cecal cancer. There were no obvious abnormalities around the ileocecal region in the preoperative examination. Postoperative pathological examination incidentally revealed a mucosal papillary adenocarcinoma of the appendix, with no residual lesion in the ESD scar. The patient was discharged on the seventh postoperative day. Synchronous appendiceal and colon cancer is extremely rare in past reports. Here, we report the case details and review previous case reports.

P557 Long-term outcomes following laparoscopic ileocecal resection without any residual lesion for Crohn’s disease: a single-center observational study

Abstract Background To describe the characteristic of Crohn’s disease (CD) patients undergoing ileocecal resection, and to analyze the long-term outcomes following surgery. Methods A retrospective study on patients undergoing ileocecal resection without any from residual disease in the remnant intestine from July 2011 to March 2020 was conducted. The clinical data and the following outcomes were evaluated. Results Among 86 CD patients, the mean disease duration was 33.4 months, 40 patients had perianal fistula. 53 patients underwent surgery due to stricture, 26 was perforation, and 7 was failure of medical therapy. 27 (31.4%) patients suffered postoperative complications. Mean follow-up was 44.4 months, 47 (54.7%) patients had an endoscopic recurrence with 9 were non-anastomotic recurrence, 20 were anastomotic recurrence, and 18 were both anastomotic and non-anastomotic recurrence, and 4 patients had a surgical recurrence. Furthermore, 41 (47.7%) had postoperative prophylaxis with 22 (25.6%) azathioprine and 17 (19.8%) infliximab. 45 (52.3%) patients were without postoperative prophylaxis, 19 (42.2%) had an endoscopic recurrence, and 26 (57.8%) had none endoscopic recurrence. The penetrating disease and lower skeletal muscle index were independent risk factors for endoscopic recurrence. Conclusion CD patients with penetrating disease or lower skeletal muscle index were suggested to have earlier postoperative prophylaxis after ileocecal resection without any from residual disease in the remnant intestine.

Postoperative Pulmonary Complication Prevention on a Laparoscopic Ileocecal Resection Patient with Left Upper Lobar Bronchial Stenosis and Severe Chronic Obstructive Pulmonary Disease

Postoperative Pulmonary Complication Prevention on a Laparoscopic Ileocecal Resection Patient with Left Upper Lobar Bronchial Stenosis and Severe Chronic Obstructive Pulmonary Disease

A Case of Appendiceal Endometriosis Diagnosed by Laparoscopic Ileocecal Resection

A Case of Appendiceal Endometriosis Diagnosed by Laparoscopic Ileocecal Resection

A Case of Intestinal Endometriosis with Intestinal Obstruction and Low-grade Appendiceal Mucinous Tumor Treated by Laparoscopic Ileocecal Resection

A Case of Intestinal Endometriosis with Intestinal Obstruction and Low-grade Appendiceal Mucinous Tumor Treated by Laparoscopic Ileocecal Resection