Lipoma Surgery Research Articles

A rare case of recurrent anemia with giant lipoma of jejunum: A case report

Lipoma of the gastrointestinal tract is a rare, benign, usually single, slow growing, non-epithelial neoplasms derived from mature adipocytes.3 The colon is the commonest site of the digestive tract with an incidence rate ~4.4%. Most of the lipomas are asymptomatic and incidentally detected.3 Lipoma should be differentiated from true neoplasia, because in most of the cases they do not need any intervention unless they cause a symptom or are large in size.3 Endoscopic resection is preferred for lipomas < 2cm and surgery for lipomas > 2cm to avoid complication such as bleeding and perforation. We report a case of a 40-year-old male, who was found to have 15cm jejunal lipoma by imaging and confirmed by histopathology.

Spinal cord lipomas: lessons learned in the era of total resection.

Recent years have seen a paradigm shift towards total/near-total resection in spinal cord lipoma surgery. As this procedure is technically challenging, surgical candidates need to be selected appropriately through accurate image assessment and classification. The purpose of this paper is to describe a surgical series of paediatric spinal cord lipomas, their diagnosis, results and complications. We undertook a retrospective review of paediatric patients with spinal cord lipomas who underwent surgery between 2008 and 2022. The variables studied were age, gender, preoperative symptoms according to the Necker Functional Score (NFS), type of lipoma according to Morota's classification, functional and radiological surgical outcomes using the cord-sac ratio (CSR), need for re-operation, complications and follow-up. A total of 25 patients (average age 36months) underwent surgery. According to Morota's classification, MRI showed 13 type 1 lipomas, two type 2, two type 3 and eight type 4. The preoperative NFS was 16.06, with urological abnormalities being the most frequent manifestation. Total/near-total resection was attempted since 2015. Five patients with type 1 lipoma required re-operation due to clinical deterioration with suspected retethering, all of them with a CSR > 0.3. The series average CSR was 0.417. This paper highlights the importance of proper classification for a correct surgical approach to obtain favourable results and minimise possible complications. Based on our experience, given our results regarding the percentage of fistulae and retethering rates, we limited radical resection to symptomatic type 1 lipomas. Our future aim is to obtain better CSR rates and to decrease the retethering percentage.

Comparison of intraoperative neurophysiological monitoring methods for lumbosacral lipoma surgery in infants.

Stable intraoperative neurophysiology monitoring of infants, especially very young infants, is challenging. In this study, motor evoked potentials (MEPs), the bulbocavernosus reflex (BCR), and somatosensory evoked potentials (SEPs) were simultaneously monitored in infants with lumbosacral lipomas, and these methods were compared retrospectively. A total of 21 surgeries performed for lumbosacral lipoma in patients less than 1year old were studied. The mean age at surgery was 133.8days (range 21-287days; ≤ 120days: 9 cases, > 120days: 12 cases). Transcranial MEPs were measured in the anal sphincter and gastrocnemius, and tibialis anterior and other muscles were added as needed. The BCR was measured by the electromyogram of the anal sphincter muscle with stimulation of the pubic region, and SEPs were measured from the waveforms of stimulation of the posterior tibial nerves. For the BCR, stable potentials could be recorded for all 9 cases at ≤ 120days of age. In contrast, for MEPs, stable potentials could be recorded in only 4 of 9 cases (p < 0.05). For all patients > 120days of age, MEPs and the BCR were measurable. SEPs were undetectable in some patients regardless of age. The BCR could be more consistently measured than MEPs in infant patients with lumbosacral lipoma at ≤ 120days of age.

Recurrent Tethering in Conus Lipomas: A Late Complication Not to Be Ignored

Recurrent symptomatic tethered cord (RTC) is a long-term complication of spinal cord lipomas, responsible for progressive motor deficits, urologic dysfunction, and aggravation of spinal deformities. We retrospectively analyzed all cases of recurrent tethering after spinal cord lipoma surgery, the clinical and radiologic features that led to the diagnosis, the surgical management, and the neuro-orthopedic outcome at the last follow-up. The study was carried out over 20 years on 209 pediatric patients from a single institution, initially treated for a conus lipoma. Nine patients (4.8%) were surgically treated for an RTC. The age at retethering ranged from 2 to 12 years (median, 7.4 years). The time until the first and the second surgical procedure ranged from 19 to 140 months (median, 92 months [7.5 years]). The follow-up period after the second surgery ranged from 3 months to 13 years (median, 50 months). Regarding symptoms, pain responded well to surgery. Gait disturbances improved in 50% of patients after surgery. One patient with bladder dysfunctions also improved. The remaining patients maintained their presurgical status. When RTC is confirmed, the child should be referred to surgery as soon as possible, because we show that the postoperative clinical outcome improved and surgery did not worsen patients' condition. Follow-up should be as long as possible for these patients.

Conus lipoma surgery in asymptomatic children: early results of total resection

Conus lipoma surgery in asymptomatic children: early results of total resection

An Acquired Diaphragmatic Hernia Masquerading as Lumbar Hernia: a Case Report

Diaphragmatic hernia can be congenital or acquired. Usual clinical presentation may range from asymptomatic cases to serious respiratory or gastrointestinal symptoms. This case report discusses a middle-aged male presenting to us with a radiological diagnosis of lumbar hernia turning out to have diaphragmatic hernia intraoperatively. A 58-year-old gentleman presented to us, 6 months back, with a slowly progressing painless lump in the left lumbar region. The ultrasonography was suggestive of lipoma. The lump was excised under general anaesthesia, and intraoperatively it was a giant lipoma of size around 12 × 10 cm2 in subcutaneous plane. Two months later, he developed swelling at the same site where he had been subjected to ambulatory excision of a lipoma. The swelling was insidious in onset and gradually progressing over the period of next 4 months, and he again visited to us. Examination revealed an ill-defined fullness in the left lumbar region with suspicious positive cough impulse. Computed tomography scan of abdomen reported it to be a large incisional hernia in the left lumbar region (in view of history of lipoma surgery in the past). The chest X-ray revealed slight blunting of left costophrenic angle, and baseline blood investigation were normal. He was electively posted and proceeded for diagnostic laparoscopy. He had a rent in left hemidiaphragm anterolaterally, and only a part of omentum was adhered to its edge. The defect was laparoscopically suture repaired with polypropylene and strengthened with a polypropylene mesh with ProTack fixation. The postoperative recovery was uneventful. This paper describes a unique presentation of spontaneous diaphragmatic hernia mimicking a lumbar hernia. To our knowledge, no similar case has been reported and published.

Surgical management of lipomas: Proposal of the Z-incision design and surgical algorithm based on tumor size.

Surgical excision is the treatment of choice for lipomas. However, linear incision methods or minimal extraction techniques often do not provide a sufficient surgical view. Therefore, removing large lipomas is often difficult. To present the Z-incision and half Z-incision designs for lipoma extraction, this retrospective study analyzed lipomas surgically excised at our institution between September 2015 and December 2018. The area of surgical field exposed by the Z-incision versus that exposed by the linear incision was calculated using a schematic model. Cure rate, complications, and surgical field area were investigated. A total of 84 lipomas were included. A Z- or half Z-incision was used to treat 30 lipomas, while a linear incision was used to treat 54 lipomas. The mean diameter of the mass in the Z- or half Z-incision group was 47.7 mm (range, 15-160 mm), larger than that in the linear incision group (25.5 mm; range, 7-59 mm) (p < .001). The Z-incision involved making rectangular windows by lifting 2 triangular flaps. According to our mathematical model, the Z-incision provided a larger surgical field area than that provided by the linear incision based on stretched angles (1.81 times larger at 30° and 3.14 times larger at 15°). The Z- and half Z-incisions were successfully performed in all but 1 lipoma (29 lipomas, 96.7%). There was 1 lipoma that resulted in postoperative complications (seroma, 3.3%). The Z-incision design can be a useful alternative technique for the extirpation of lipomas, especially large lipomas. Here, we proposed a surgical algorithm for lipoma surgery based on tumor size.

Intraoperative rectal ampullar manometry in spinal cord conus lipoma surgery in children

Objective . To assess a potential of using intraoperative rectal ampullar manometry to prevent bladder dysfunction in surgical treatment of the spinal cord conus lipoma. Material and Methods . The results of surgical treatment of 59 children with lipomas of the spinal cord conus were studied. The presence of urological symptoms (urinary retention or incontinence) was assessed before and after surgery. Intraoperative rectal ampullar manometry was performed in 22 cases with registration of signs of irritation (increased pressure in the rectal ampulla) and depression (decreased pressure in the rectal ampulla) of sacral parasympathetic centers which allowed controlling their proximity and tolerance to the performed manipulations. Results . Urological symptoms before surgery were detected in 25 (42 %) patients: urinary retention in 7 (28 %), and incontinence in 18 (72 %). Symptoms were significantly more often detected in children older than 3 years (p 3 mm Hg) have precluded from the total removal of lipoma in all 22 patients; subtotal or partial lipoma removal and release of the tethered spinal cord were achieved in all cases. None of the patients operated on using rectal ampullar manometry presented urinary retention after surgery, these disorders developed in 12 (32 %) children operated on without this procedure (p < 0.05). Conclusion . Paresis or paralysis of the bladder detrusor after removal of the spinal cord conus lipoma may result from direct damage to the parasympathetic sacral centers located at the borderline between the lipoma and the spinal cord. The method of intraoperative rectal ampullar manometry allows protecting the functions of the pelvic organs and determining the safe volume of lipoma resection.

Surgery for Lipomas should not be Estimated as Simple as Their Name Implies

Surgery for Lipomas should not be Estimated as Simple as Their Name Implies

How I Do It: Spinal Cord Lipomas

Basados en la experiencia de 82 casos; en 5% se observaron anomalías pélvicas asociadas. En los menores de 3 años el motivo de consulta (85%) fue la tumoración. En los mayores de 3 años (42%) tenía problemas neurológicos. Solo el 24% preocupados por la tumoración. El objetivo de la cirugía es desanclar la médula y no remover la totalidad del lipoma. El lipoma de filum es el que es mas simple para operar. Aún cuando la escuela francesa propone operar solamente cuando hay síntomas favorezco cirugía preventiva. Favorezco una segunda cirugía si hay signos de anclaje postoperatorio, aún cuando observamos empeoramiento postoperatorio motor en 2.5% de los operados y urológico a largo plazo en 6% de los operados.

Liposuction for removal of lipomas in 20 dogs

To review the success rates for liposuction of lipomas in dogs, report early complications and medium-term outcomes and formulate recommendations on the most appropriate candidates for liposuction. Retrospective study of 20 dogs with 76 lipomas diagnosed by cytology, in which dry liposuction was attempted. Case records were reviewed for number and size of the lipomas, efficacy of liposuction, frequency and types of complication and likelihood of recurrence. Liposuction was successful in removing 73 of 76 lipomas (96%). Simple, encapsulated lipomas less than 15 cm in diameter were most easily removed, with minimal risk of complication. Giant lipomas contained fibrous trabeculae that hindered liposuction and resulted in poor fat retrieval. Giant lipomas were also associated with a high risk of bruising, haematoma and seroma, especially when inguinal in location. Regrowth was noted at follow-up between 9 and 36 months in 28% of lipomas. Liposuction may be less invasive and more attractive to owners than conventional surgery for lipomas up to 15 cm in diameter. Liposuction is not recommended for infiltrative or giant inguinal lipomas. Regrowth can be expected in a high proportion of lipomas, which should be considered when choosing liposuction over conventional excision.

Transient Allodynia Following Caudal Lipoma Excision: A Case Report

Allodynia is the sensation of pain due to non-painful stimuli. It usually occurs due to destructive lesions of the spinal cord or peripheral nerves. Allodynia following intradural lipoma surgery has been reported previously. We herein report a case of allodynia developed after microsurgical caudal lipoma excision without associated spinal cord injury.

Long-Term Outcome of Total and Near-Total Resection of Spinal Cord Lipomas and Radical Reconstruction of the Neural Placode, Part II

To show the long-term benefits of total and near-total resection of complex spinal cord lipomas and reconstruction of the neural placode. We analyzed 238 patients with dorsal, transitional, and chaotic lipomas who had total resection as described in part I for overall progression-free survival probability (PFS, Kaplan-Meier analysis) over 16 years. We also analyzed subgroup proportional recurrence hazard (Cox analysis) of 6 outcome predictors of sex, lipoma type, age, preoperative symptoms, previous surgery, and postoperative cord-sac ratio. These results were compared with an age-matched, lesion-matched series of 116 patients followed for 11 years after partial lipoma resection and with the Parisian series of nonsurgical treatment. The immediate effects of surgery were similar between total and partial resection: both achieved greater than 95% symptom stabilization or improvement rate. The neuro-urologic complication rates for the groups were also similar, 4.2% and 5.2% for total and partial resection, respectively. The combined cerebrospinal fluid leakage and wound complication rate of total resection was much lower at 2.5% than the 6.9% for partial resection, but both were better than published rates. The overall PFS for total resection was 82.8% at 16 years, comparing much more favorably with 34.6% for partial resection at 10.5 years (P < .0001). Culling only the asymptomatic patients with virgin (previously unoperated) lipomas to match the patient profile of the Parisian series, the PFS for prophylactic total resection for this subgroup increased to 98.4% at 16 years, versus 67% at 9 years for no surgery and 43.3% at 10.5 years for our own partial resection series, with a remarkable statistical difference between total and partial resection (P = .00001). Subgroup analyses showed that sex and lipoma type did not affect outcome. For the other predictor variables, while univariate analyses showed that young age, absence of symptom, and virgin lipomas correlated with better statistical PFS than older age, symptoms, and redo lipomas, these effects vanished with multivariate analyses. Cord-sac ratio stood alone as the only influential outcome predictor in multivariate analysis, with a 96.6% PFS for a low ratio of <30% and an 80.6% progression-free probability for a high ratio of >50%, and a 3-fold increase in recurrence hazard for high ratios (P = .0009). This suggested that all the individual effects of the other predictor variables could be reduced to whether a low cord-sac ratio could be achieved with total lipoma resection and placode reconstruction. Cord-sac ratio was the obvious factor that differentiated the outcomes between total and partial resection, the latter associated with a >90% chance of having a high cord-sac ratio. Total and near-total resection of lipomas and complete reconstruction of the neural placode produced a much better long-term progression-free probability than partial resection and nonsurgical treatment. The perioperative complications for total resection were low and compared favorably with published results. A low postoperative cord-sac ratio and well-executed placode neurulation were strongly correlated with good outcome. The ideal preoperative patient profile with early disease stabilization and the best recurrence-free probability is an asymptomatic child less than 2 years without previous lipoma surgery. There are strong indications that partial resection in many cases produces worse scarring on the neural placode and worse prognosis than no surgery.

Value of Electrophysiological Assessment After Surgical Treatment of Spinal Dysraphism

Value of Electrophysiological Assessment After Surgical Treatment of Spinal Dysraphism

Spinal Lipomas in Children

Spinal cord lipomas are a common cause of cord tethering that can lead to progressive neurological defects. The role of prophylactic surgery for spinal lipomas has recently been questioned. Between 1985 and 1999, 59 children underwent a total of 69 surgical procedures at the Birmingham Children’s Hospital in Birmingham, UK. The spinal lipomas were classified into: 18 terminal, 17 transitional, 6 dorsal and 18 filum lipomas – including 12 who had a typical thickened filum terminale. At the first operation, 19 patients (32%) were asymptomatic, and 40 patients (68%) presented with symptoms. Surgical indications in the asymptomatic group included the presence of a dermal sinus tract or syrinx. Prophylactic surgery was undertaken in selected cases. The mean total follow-up for the group since the first surgical procedure was 61.8 months (range: 7.0–203.0 months). In the asymptomatic group, 26% of the patients had late neurological deterioration. Of the 14 patients with asymptomatic conus lipomas, 3 (21%) developed sphincter dysfunction and motor problems at long-term follow-up. In the symptomatic group, 68% improved, 20% remained unchanged, and 12% had late neurological deterioration. None of the 18 patients with symptomatic filum lipoma deteriorated postoperatively. However, 39% had bladder dysfunction, 54% had neuro-orthopaedic deformity, and only 15% returned to overall normal function at latest follow-up. Of the 27 patients with symptomatic conus lipomas, 67% improved, 15% remained stable, and 18% had late neurological deterioration. However, 74% had bladder dysfunction, 67% had neuro-orthopaedic deformity, and 45% had motor problems at long-term follow-up. Spinal lipomas can cause progressive neurological deficits irrespective of spinal untethering surgery. This study demonstrates that filum and conus lipomas have similar clinical presentation, but differ in their outcome following surgery. Filum lipomas are ‘benign’, for which surgery is safe and effective. Conus lipomas are more difficult to manage. When asymptomatic, our results suggest that prophylactic surgery does provide some protection from future neurological deterioration. When symptomatic, conus lipoma surgery is effective in stopping further deterioration. Improvement in neurological function can occur, but few patients return to normal overall function, and pre-existing sphincter dysfunction is not significantly altered by surgery.