Laparoscopic Trocar Site Research Articles

OC-072 COMPARATIVE STUDY OF THE TROCAR SITE INCISIONAL HERNIA INCIDENCE ACCORDING TO SLOW VS RAPID ABSORPTION SUTURES

Abstract Aim Abdominal wall closure guidelines recommend the utilization of slow absorption sutures. However, fast absorption sutures are still used for laparoscopic trocar site closure, mainly due to ease of handling and availability. We planned a retrospective cohort study, analysing the incidence of trocar site hernia (TSH) depending on the suture used for the fascial closure. Materials & Methods A retrospective cohort study is carried out including a sample of 200 patients operated in our centre by any elective laparoscopic procedure, by Hasson access technique at the umbilical trocar site. Patients were distributed in 2 groups, according to the suture used: Group-1 Polyglactin, Group-2 Polydioxanone. In both groups the needle that was employed had a J-shape. Patients that had open or robotic surgery, reinterventions, and previous diagnosis of umbilical hernia were excluded. Results 100 patients were included in Group-1, and 100 patients in Group-2. The average age was 57.34 and 63.39 years respectively. The incidence of TSH in Group-1 was 20% with an average follow up of 22.3 months, compared to an 15% TSH incidence in Group-2, with an average follow-up of 20.3 months. These differences were not statistically significant. 80% of TSH were diagnosed in the first 24 months after the surgery. Conclusions Likewise the existing evidence in open surgery wall closure, the use of slow absorption sutures in trocar site closure probably reduces the TSH incidence, without repercussion in comorbidity, however, in our study, the sample was not enough to prove statistical significance. These results should be contrasted with further randomized Control Trials.

Laparo-endoscopic Rendezvous in the Treatment of Cholecystocholedocholithiasis: A Single Center Initial Experience

Cholecystocholedocholithiasis is a common disease worldwide; however, there is still no consensus regarding a gold standard therapy for its management. Nowadays, the preferred method is a “two-step” process, starting with an endoscopic common bile duct (CBD) stone extraction (endoscopic retrograde cholangiopancreatography [ERCP]) followed by a laparoscopic cholecystectomy (LC). Nevertheless, this “two-step” approach has shown some difficulties over time (i.e., need for two hospital admissions, need of at least two anesthesia inductions, higher rate of post-procedural pancreatitis, longer hospitalizations and thus, increased costs). On the other hand, the laparo-endoscopic rendezvous (LER), which is a simultaneous combined procedure for removing the gallbladder laparoscopically and clearing the CBD endoscopically, is another valid treatment modality that involves a “single-step” resolution of cholecystocholedocholithiasis applying a multidisciplinary approach of the patient. The aim of this study was to present our initial outcomes. We retrospectively analyzed eleven patients who consecutively underwent LER at our institution from May 2017 to March 2022. The patients’ mean age was 50.6 years old (range, 34 - 68) and most were male 54.5% (6/11). LER successfully achieved CBD stone clearance in 90.9% (10/11) of the cases. Post-LER pancreatitis was not recorded in any case. Post-operative complications included one reoperation (1/11; 9.1%) due to bleeding from one of the laparoscopic trocar sites. Our group concluded that LER can be effectively applied in Perú with good mid-term results and confirmed its effectiveness in accomplishing C sults, we recommend the use of LER as a safe and valid therapeutic option for our patients.

995 Skin Closure in Laparoscopic Surgery – a UK Based Cross-Sectional Survey

Abstract Introduction Effective port site closure is a major mediator of patient-reported outcome measures. Traditionally, subcuticular sutures are used to close laparoscopic trocar sites. However, this can be challenging and time-consuming to achieve an effective cosmetic outcome. Skin re-approximation using tissue adhesives, such as octylcyanoacrylate, has benefits associated with aftercare, cosmesis, time-efficiency, and wound complication rates attributed to favourable bacteriostatic properties. Despite this, there remains poor uptake of its use in clinical practice. Our aim was to gain insight into port-site closure techniques favoured by a sample of laparoscopic surgeons. Method A standardised questionnaire was developed and distributed electronically to surgeons in the United Kingdom. Questions were pertaining to closure material and technique. Data was collected prospectively and analysed using Prism GraphPad. Results 63 surgeons; including 32 consultants, 22 senior trainees, 8 junior trainees and 1 allied healthcare professional participated in the study. Regarding port sites <5mm we found; 50.79% (n=32) used subcuticular sutures, 14.28% (n=9) used glue alone, and 23.80% (n=15) used glue in combination with sutures or steri-strips. For larger port sites >5mm we found 61.90% (n=39) used subcuticular sutures, 6.34% (n=4) used glue alone and 22.22% (n=14) used subcuticular sutures and glue in combination. 9.52% (n=6) used other methods of closure such as staples and sutures in combination with steri-strips. Conclusion Despite the many benefits of skin adhesive assisted closure, its uptake remains low in clinical practice. We suggest an approach targeting improvements in awareness and education to positively impact decision making regarding methods of trocar site closure.

Ultrasound-guided Transversus Abdominis Plane Block is Effective as Laparoscopic Trocar site infiltration in Postoperative Pain Management in Patients Undergoing Adrenal Surgery.

Pain management in patients undergoing laparoscopy is still a matter of debate as several techniques have been proposed to reduce postoperative analgesic consumption and improve recovery. Among these, transversus abdominis plane (TAP) block is considered as safe, effective, and easy to perform under ultrasound guidance; even so, recently laparoscopically guided trocar site anesthetic infiltration has been proposed as a "surgeon-dependent alternative to TAP block." The aim of this evaluation is to compare these analgesic techniques in the setting of laparoscopic adrenalectomy. This is a retrospective evaluation of a prospectively maintained database. Patients were divided into two groups: Group A patients received laparoscopic-assisted trocar site infiltration of ropivacaine; Group B patients received bilateral ultrasound-guided TAP block with ropivacaine. All patients received 24h infusion of 20mg morphine postoperatively; pain was checked at 6, 24 and 48h after surgery. A rescue analgesia was given if numerical rating scale (NRS) score was > 4 or on patient request. One hundred and three patients were enrolled in the evaluation (57 in group A and 46 in group B). There were no differences in operative time, complications and postoperative stay, and no complications related to trocar site infiltration. There were no differences in NRS at 6, 24, and 48hours as well as in patients requiring further analgesic administration. Laparoscopic-guided trocar site ropivacaine infiltration has similar pain outcomes compared to ultrasound-guided TAP block in the management of postoperative pain in patients undergoing laparoscopic adrenalectomy. Since there is no difference among these techniques, the decision can be based on surgeon or anesthesiologist preference.

Malignant transformation of endometriosis in a laparoscopic trocar site a case report

BackgroundMalignant transformation of endometriosis is infrequent at the laparoscopic trocar site. Although malignant transformation is uncommon, it must be acknowledged in order to achieve radical resection.Case presentationWe report on a 54-year-old woman with trocar site endometriosis 2 years after laparoscopic ovarian endometrial resection. Physical examination revealed a subcutaneous solid tumor with a diameter of 3 cm surrounding the scar of laparoscopic surgery in the right lower abdomen. Transabdominal ultrasonography showed a cystic tumor in the subcutaneous adipose layer of the right lower abdomen. The pathological diagnosis was poorly differentiated endometrioid carcinoma. Hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy were then performed. Histological examination revealed mixed endometrioid carcinoma and clear cell carcinoma. After six cycles of chemotherapy, computed tomography showed no signs of recurrence.ConclusionsMalignant transformation of laparoscopic endometriosis is very uncommon, and the diagnosis and stage are determined by clinical manifestations and imaging examination. The main therapy methods are radical surgery combined with neoadjuvant chemotherapy and adjuvant radiotherapy. At the same time, reducing iatrogenic abdominal incision implantation is an effective prevention method.

Scary Disseminated Peritoneal Parasite Tumors: A Rare Complication after Previous Laparoscopic Myomectomy

<h3>Study Objective</h3> To demonstrate a rare case with complications originated from previous uncontained power morcellation for laparoscopic myomectomy specimen. <h3>Design</h3> Video demonstration of a rare case. <h3>Setting</h3> A local MIS (minimally invasive surgery) center. <h3>Patients or Participants</h3> <b>S</b>ingle patient. <h3>Interventions</h3> Laparoscopic surgery. <h3>Measurements and Main Results</h3> This virgin patient, receiving laparoscopic myomectomy 9 years ago at other hospital, received 2^nd laparoscopic surgery for recurrent symptomatic uterine myomas 5 years ago, when she was 40-year-old of age. Numerous intraperitoneal parasite tumors were noted. Part of the tumor was sent for frozen section, and the result was "spindle cell tumor". These tumors were debulked as possible. Anterior and posterior uterine mass were also removed after careful adhesiolysis. At this time, all the specimens were removed in the retrieval bag. The pathology of the "parasite tumor" was not leiomyoma but turned out to be adenomyosis and adenomatoid tumor. Adjuvant hormone suppression was prescribed, but later was stopped by patient herself due to the untolerable side effect. Recurrent intraperitoneal adenomyomatosis was noted soon after, gradually enlarged, and at last caused serious compression symptoms. She received 3^rd laparoscopic surgery last year (44-year-old of age). Severe intraperitoneal adhesion, with multiple peritoneal tumor seeding (including Morrison pouch, paracolic gutter, mesentery, pararectal area, and previous laparoscopic trocar site), were noted. TLH + BSO, as well as parasite tumor resection/debulking was performed as the final definite surgical treatment. The patient recovered soon after the surgery and lived well now. In this short video, we will only demonstrate the terrible condition of intraperitoneal adenomyomatosis during 2nd debulking surgery. <h3>Conclusion</h3> Intraperitoneal leiomyomatosis or adenomyomatosis is a rare but serious complication following laparoscopic myomectomy procedure. Castration (BSO) may be the final solution to prevent recurrent parasite tumor seeding and growing. From this patient's history, we again learned the importance of contained morcellation during specimen retrieval in laparoscopic myomectomy.

Sutureless energy-based wound closure: a step in the quest for trocar site hernia prevention

Objective Easy and safe methods of fascia closure are needed in order to reduce the risk for trocar site hernias without affecting procedure time significantly. Here we present a method for port site closure using heat induced collagen denaturation. Material and methods Controlled heat-induced collagen denaturation was applied to laparoscopic trocar sites in living porcine animal models. These were compared to control trocar sites which were left open. Port sites were evaluated visually at days 14 and 28 after the procedure, and both visually and pathologically at post-procedural day 42. Results A total of 12 port sites were evaluated in three pigs. No incisional hernias were noted at any of the trocar sites in both groups. Histological evaluation revealed that one of the six control ports appeared to have a complete transfascial defect, whereas none of the study group trocars showed this finding. Furthermore, the study port sites showed a more robust scarring pattern. Conclusions Heat-induced collagen denaturation in this preliminary study was found to be safe and allowed better scarring of the healing port sites. We believe that this technology may offer a safe and efficient closure of laparoscopic trocar sites. More studies are needed to further evaluate the true effectiveness of this technology.

Resident Involvement in Laparoscopic Sacrocolpopexy: A Review of Operative Times and Surgical Outcomes

Study Objective To evaluate laparoscopic sacrocolpopexy operative times, complication rates and long-term surgical outcomes at one academic institution with significant trainee involvement. Design This is a retrospective chart review of laparoscopic sacrocolpopexy cases. Setting Cases took place in an operating room at a large academic medical center. Patients were in dorsal lithotomy position with five abdominal laparoscopic trocar sites. Patients or Participants A series of 181 consecutive laparoscopic sacrocolpopexy cases (with or without concomitant procedures) were examined between February 2014 and August 2019. Interventions None. Measurements and Main Results Descriptive statistics were used to compare primary outcomes with published literature. The average operative time was 139.9 minutes, compared to 180-190 minutes noted in other studies. Four cases of intraoperative cystotomy (2.2%) and one enterotomy (0.6%) were noted compared to 5-6% and 1.4% respectively in the literature (Sheyn et al 2019). There were 16 cases of postoperative urinary tract infection (8.8%). At their most recent postoperative visit, which occurred on average at postoperative day 278, recurrent prolapse was noted in 11.7% of patients and 3.9% of those patients underwent a subsequent repair to correct their prolapse. Other complications included 0.6% small bowel obstruction, 1.1% mesh erosion and 7.7% de-novo stress urinary incontinence; all of these were less than those documented in the literature. The overall complication rate was 15.4% compared to 18% in the literature (Nosti et al 2014). Conclusion This institutional demonstrates short operative times, low complication rates and favorable outcomes with resident involvement in laparoscopic sacrocolpopexy. This indicates advanced urogynecology procedures can be performed with significant resident involvement without compromising operative time and surgical outcomes.

A Unique Approach for Total Laparoscopic Hysterectomy and Excision of Endometriosis at Time of Abdominoplasty

Video Objective We describe a unique technique to hide trocar scars while performing concurrent laparoscopic hysterectomy and excision of endometriosis at the time of abdominoplasty. Setting This patient is a 40 y/o female undergoing concomitant abdominoplasty and hysterectomy for chronic pelvic pain, abnormal uterine bleeding, and suspected endometriosis. Combining abdominoplasty with gynecologic surgery reduces total anesthesia and operative times, intraoperative blood loss, hospitalization and total recovery time when compared with having both of the procedures performed separately. Additionally, combined surgery does not appear to be associated with an increase in complications. Interventions We perform a total laparoscopic hysterectomy (TLH) and excision of endometriosis with concomitant abdominoplasty. First, the abdominoplasty flap is raised by the plastic surgeon. Then, the TLH and excision of endometriosis is performed. Finally, the rectus is plicated, excess tissue is excised, and the abdominoplasty is completed. Conclusion Performing concomitant total laparoscopic hysterectomy and abdominoplasty offers many benefits to the patient including shorter total operative and anesthesia, as well as shorter recovery when compared to 2 separate procedures. There are no large fascial defects when the hysterectomy is performed laparoscopically with 5 mm ports, so there is minimal concern for hernia or fascial dehiscence. The laparoscopic approach also offers a detailed survey for endometriosis lesions which can be excised at the same time as hysterectomy for definitive therapy. Aesthetically, the laparoscopic trocar sites are hidden when utilizing this technique, which is advantageous for cosmesis.

Secondary pregnancy by an implant in a laparoscopic trocar site

For nearly 20 years, laparoscopy has been generally regarded as the gold standard for the surgical treatment of ectopic pregnancy and its application is very widespread. According to our knowledge, secondary pregnancy at the laparoscopic trocar site has not yet been reported until now. A 24-year-old Chinese female patient is reported herein. Her left fallopian tube was removed via laparoscopy due to a first ectopic pregnancy. Her postoperative blood β-human chorionic gonadotropin (β-hCG) was increasing with irregular vaginal bleeding. The patient was initially regarded as having an old ectopic pregnancy. Secondary pregnancy by an implant in a laparoscopic trocar Site. Because of secondary pregnancy at the laparoscopic port site, laparoscopic surgery was performed again 32 days after the first operation. Approximately 1000 milliliters (mL) of free intraperitoneal hemorrhage and active bleeding of the lesion were detected. Histopathologic examination confirmed the lesion was the result of pregnancy with visible villous tissue. Her blood β-hCG gradually declined to a normal range in 28 days after the second operation. Menstruation occurred on day 20 after the second operation, and the duration and quantity were normal. Although laparoscopy has many advantages, secondary pregnancy at the laparoscopic trocar port wound caused the patient enormous physical and mental pain and increased the medical costs. The etiology of secondary ectopic pregnancy at the laparoscopic puncture site was mainly an iatrogenic factor. Therefore, the procedure should be standardized to avoid its occurrence.

Sporadic Desmoid-Type Fibromatosis Occurring at Laparoscopic Trocar Site: An Unusual Entity.

Desmoid-type fibromatosis (DF) or desmoid tumours are rare benign soft tissue tumours of musculo-aponeurotic origin, which have no malignant potential but are locally aggressive and can result in significant morbidity. They may be hereditary (in association with FAP, i.e. familial adenomatous polyposis syndrome resulting from APC gene mutation) or sporadic, with hereditary cases having a much higher risk of developing DF compared to sporadic ones. Desmoids are known to occur in previous surgical scars. However, previous laparoscopic port site/trocar site is an extremely uncommon site for sporadic desmoids, with only two cases of sporadic laparoscopic trocar site desmoids (occurring in absence of FAP) reported in world literature. We thus describe a case of sporadic DF, occurring at the site of umbilical port 8months following laparoscopic cholecystectomy for cholelithiasis, treated successfully by margin-negative resection. To the best of our knowledge, this appears to be the first such case in Indian literature and the first being reported after laparoscopic cholecystectomy. In the era of laparoscopic surgery, one must be aware of the existence of such an entity after laparoscopy as it may be confused with conditions such as metastatic deposit, port site tumour recurrence, port site hernia, scar site endometriosis, soft tissue sarcoma etc. and may result in diagnostic dilemma.

A new technique for laparoscopic trocar site closure in dogs.

A new technique for laparoscopic trocar site closure in dogs.

Incarcerated umbilical Littre’s hernia at the trocar site of a previous laparoscopic surgical procedure

Prevalence of Littre's hernia (protrusion of a Meckel´s diverticulum through an opening in the abdominal wall) is very low, and Littre's hernias found in an umbilical site are uncommon. Even rarer are cases of an incarcerated hernia resulting in a surgical emergency. Trocar-site hernias are a relatively common complication after laparoscopic cholecystectomy that develop in association with insertion of wide trocars (usually at the umbilical port). A 63-year-old female with a history of obesity, diabetes mellitus, hypertension, laparoscopic cholecystectomy and open hysterectomy arrived at hospital complaining of acute umbilical pain but with no other symptoms or fever. A painful mass observed was believed to be an incarcerated umbilical hernia at a trocar site used in previous laparoscopic surgery. Emergency surgery was undertaken: the opening of the hernia sac revealed a Meckel's diverticulum within it. The Meckel's diverticulum was resected using a stapler, followed by herniorrhaphy and hernioplasty. Postoperative recovery was uneventful. An incarcerated umbilical Littre's hernia at a laparoscopic trocar site has not been reported before. To avoid this complication, we agree with the numerous authors who recommend closure of trocar sites of width ≥10mm.

A5109 - Is The Prevalence of Laparoscopic Trocar Site Hernias as Low as Reported in the Literature?

A5109 - Is The Prevalence of Laparoscopic Trocar Site Hernias as Low as Reported in the Literature?

Evaluation of a Novel Trocar-Site Closure and Comparison with a Standard Carter-Thomason Closure Device

The aim of this study was to evaluate and compare a novel trocars-site closure device, the WECK EFx™ Endo Fascial Closure System (EFx) with the Carter-Thomason CloseSure System® (CT) for the closure of laparoscopic trocar site defects created by a 12-mm dilating trocar. We created standardized laparoscopic trocars-site abdominal wall defects in cadaver models using a standard 12-mm laparoscopic dilating trocar. Trocar defects were closed in a randomized fashion using one of the two closure systems. We recorded time and number of attempts needed for complete defect closure. In addition, we recorded the ability to maintain pneumoperitoneum, endoscopic visualization, safety, security, and facility based on the surgeon's subjective evaluations. We compared outcomes for the EFx and CT closure systems. We created 72 standardized laparoscopic trocars-site abdominal wall defects. The mean time needed for complete defect closure was 98.53 seconds (±28.9) for the EFx compared with 133.61 seconds (±54.61) for the CT (P<0.001). The mean number of attempts needed to achieve complete defect closure were 1.19 (1-3) for the EFx and 1.19 (1-2) for the CT (P=0.50). Mean scores for safety were 2.92 for EFx vs 2.19 for CT (P<0.001). Mean scores for facility were 2.97 vs 1.83 for EFx and CT, respectively (P<0.001). Mean scores for maintenance of pneumoperitoneum were 1.97 for EFx vs 2.33 for CT (P=0.022). No significant difference was observed between the EFx and the CT systems for endoscopic visualization (2.28 vs 2.50, P=0.080). In this in vitro cadaver trial, the EFx was superior in terms of time needed to complete defect closure, safety, and facility. CT was superior in terms of maintenance of pneumoperitoneum. Both systems were equal in the number of attempts needed to complete the defect closure and endoscopic visualization.

Development of an animal model to investigate optimal laparoscopic trocar site fascial closure

BackgroundThe rate of hernia formation after closure of 10–12 mm laparoscopic trocar sites is grossly under-reported. Using an animal model, we have developed a method to assess trocar site fascial dehiscence and the strength of different methods of fascial closure. Materials and methodsPigs (n = 9; 17 ± 2.5 lbs) underwent placement of 12 mm Hasson trocars with pneumoperitoneum maintained for 1 h. Three closure techniques (Figure-of-eight; simple interrupted; pulley) were compared with no fascial closure and to native fascia at five randomly allocated abdominal wall midline locations. Necropsy was performed on the fourth postoperative d. Statistical comparisons of tensile strength and breaking strength based on closure type and trocar location were made using ANOVA with Tukey’s tests. ResultsThe mean (SD) force (Newtons) required for fascial disruption varied significantly with closure type [Native Fascia 170 (39), Figure-of-eight 169 (31), Pulley 167 (59), Simple Interrupted 151 (27), No Closure 108 (28)]; P = 0.007. The mean force required for fascial disruption was significantly increased for Native Fascia, Figure-of-eight, and Pulley relative to No Closure (P = 0.013, P = 0.015, P = 0.023, respectively). The mean (SD) force (in Newtons) required for fascial disruption also varied significantly with location of trocar [subxiphoid 181 (43), supraumbilical 151 (23), Umbilical 146 (23), infraumbilical 168 (62), suprapubic 120 (38)]; P = 0.03. The mean force for subxiphoid location was significantly increased relative to the suprapubic location (P = 0.021). ConclusionsWe have developed a novel assessment model that reliably detects differences in fascial integrity after laparoscopic trocar placement and closure. This model will allow for further testing of various trocars and closure techniques, and facilitate hernia prevention strategies.

Development of an Animal Model to Investigate Optimal Laparoscopic Trocar Site Fascial Closure

Development of an Animal Model to Investigate Optimal Laparoscopic Trocar Site Fascial Closure

Randomized Prospective Trial on the Occurrence of Laparoscopic Trocar Site Hernias

Laparoscopy has become the gold standard in an increasing number of procedures. We analyze the incidence of trocar site hernias (TSH) and determine whether closure of the external fascia prevents onset of TSH and possible complications. We performed a simple-blind randomized trial with two groups, one in which all the orifices were closed by suturing the external fascia of the abdominal wall (group A), and another in which the orifices were left open, closing only the skin (group B). Monitoring for TSH lasted 2 years from the intervention. The trial has been registered at www.clinicaltrials.gov with the clinicaltrials.gov identifier number: NCT01240434. A total of 195 patients were randomized. Thirty-three were removed from the study after conversion to open surgery, early open reoperation, or loss to follow-up. The remaining 162 patients comprised the study population, 80 in group A and 82 in group B. We found no differences between the groups regarding basic demographic data, kind of surgery, or topographic distribution of the trocars. Five TSH were diagnosed-four in group A and one in group B (P=.176)-and there was no relation between TSH and trocar size (11 or 12 mm) or location. We found 10 wound infections, 7 in group A and 3 in group B (P=.154). Our study suggests that the onset of TSH does not depend on trocar size or location. There is no evidence that suture of the fascial defect prevents the onset of TSH. In addition, we found a trend toward a higher incidence of wound infection among patients in whom the fascia had been sutured.

Closure of Ascites Leaks with Fibrin Glue Injection in Patients with End-Stage Liver Disease

Ascites leaks (AL) in patients with end-stage liver disease (ESLD) are associated with significant morbidity and mortality regardless if they are medically or surgically managed. In a pilot study, 14 ESLD patients with AL underwent treatment with fibrin glue injection around the leak after failing conservative therapy. The end point of this study was the cessation of AL in the short term and the maintenance of a leak-free abdomen in the long term, allowing for medical optimization of the patients. Median age of the 10 men and 4 women was 50 (range 26-67) years. Underlying ESLDs were chronic hepatitis C (n=5), alcoholic LD (n=2), cryptogenic cirrhosis (n=2), and miscellaneous (n=5). There were six leaking incisions posthernia repair (three umbilical and three inguinal), two leaking/ruptured umbilical hernias, four leaking paracentesis sites, one leaking Jackson-Pratt (JP) drain canal, and one leaking laparoscopic trocar site. Average AL volume per day was 1000 (range 400-2000) mL. All leaks were immediately resolved with a 3-5 mL fibrin glue injection. Five recurred and required a second injection (four within 24 hours). Mental status improved in 7 patients (West Haven Criteria: grade II to I [n=6], grade III to I [n=1]). Median model of end-stage liver disease scores improved from 23 (range 8-33) to 20 (range 14-26). There were no infections, bleeds, or other injection-related complications. Average follow-up for these patients was 441.6 days (range 2-852). Five patients underwent liver transplant (LT) median 15 (range 4-270) days postinjection; 2 of them died. Another 3 patients died (2 from sepsis and 1 from metastatic cancer). Fibrin glue injection for the control of AL is a simple and safe bedside procedure that quickly controls AL, allowing for patient recovery in anticipation of further care.

Desmoid tumor arising in a laparoscopic trocar site after cholectomy

Desmoid tumor arising in a laparoscopic trocar site after cholectomy