MesoTIPS: Combined Approach for the Treatment of Portal Hypertension Secondary to Portal Vein Thrombosis – A Brief Report

Introduction: We describe a technique we call “Meso-transjugular intrahepatic portosystemic shunt (MTIPS)” for relief of portal hypertension secondary to portal vein thrombosis (PVT) using combined surgical and endovascular technique. Materials and Methods: Nine adult patients with PVT underwent transjugular intrahepatic portosystemic shunt through a combined transjugular and mesenteric approach (MTIPS), in which a peripheral mesenteric vein was exposed through a minilaparotomy approach. The right hepatic vein was accessed through a transjugular approach. Mechanical thrombectomy, thrombolysis, and angioplasty were performed when feasible to clear PVT. Results: All patients had technically successful procedures. Patients were followed up for a mean time of 13.3 months (range: 8 days to 3 years). All patients are still alive and asymptomatic. Conclusion: We conclude that MTIPS is effective for the relief of portal hypertension secondary to PVT.

Minilaparotomy for biliary ileus: A different approach

Introduction: Biliary ileus is a rare cause of mechanical bowel obstruction and results from the passage of gallstones into the small bowel. Case presentation: 62-year old woman with episode of biliary ileus was underwent to minilaparotomy (5 cm) to extract gallstone from small bowel. In this particularly patient we used this approach, because we had highly suspicious diagnostic. The patient was discharged on postoperative day 5 without any complication. Conclusion: Minilaparotomy approach is a feasible option in centers without laparoscopy surgery, with excellent results when one-stage procedure is not considered.

Comparison of Three Different Minimally Invasive Procedures of Distal Gastrectomy for Nonoverweight Patients with T1N0-1 Gastric Cancer

Laparoscopic-assisted distal gastrectomy has recently come to be a standard procedure for the treatment of early gastric cancer1–5 in select patients. The minimal invasiveness associated with laparoscopic procedures for the resection of gastrointestinal cancer has been repeatedly explained in part by the short incision that is required.6–11 We used two different approaches to perform distal gastrectomies for the resection of gastric cancer as minimally invasive alternatives to a standard laparoscopic approach prior to our surgical team's complete mastery of the skills required for laparoscopic oncological surgery for gastric cancer.9,12 If the minimal invasiveness associated with laparoscopic-assisted gastrectomy can be explained by the small incision, a gastrectomy via a small incision without the use of a pneumoperitoneum may provide a similar outcome in patients. However, to our knowledge, such a comparison has not been previously made. We compared the minimal invasiveness of three different approaches (minilaparotomy, minilaparotomy approach with laparoscopic assistance, and standard laparoscopic-assisted approach) to performing a distal gastrectomy for T1N0-1 gastric cancer in nonoverweight patients (body mass index, ≤25 kg/m2) performed within a limited study period.

Prepubic Minilaparotomy as the Surgical Approach in Treatment of Prostate Disorders in Dogs. A Cadaver Study

The aim of the study was to assess the prepubic minilaparotomy approach in the surgical treatment of prostatic disorders in dogs. The technique of a limited approach to the prostate was developed on the fresh cadavers of 14 intact adult male dogs, diversified in regard to size and body weight. The abdominal cavity was opened in midline, from the right-sided prepubic parapenile incision. The cut was limited to 7 cm. Afterwards, it was expanded by self-retaining retractors: Gelpi, Weislander, Finnochetto Baby, and Adson. Finnochetto Baby and Gelpi retractors used in pairs enabled an adequate exposition of the prostate in small dogs. The Finnochetto Baby retractor enabled an adequate exposition of the prostate in medium dogs and the Adson retractor - in large and giant dogs. The Weislander and Gelpi retractors used individually did not allow for sufficient access to the prostate in any group of the cadavers. Prepubic minilaparotomy can be a useful surgical approach in the treatment of prostate disorders in dogs. It can be used especially for minor surgical procedures, e.g. sampling of large tissue specimens for histopathological examination, partial prostatectomy, or treatment of intraparenchymal cavitary lesions.

Minilaparotomy for Perforated Duodenal Ulcer

The usefulness of the minilaparotomy approach for perforated duodenal ulcer repair was retrospectively evaluated in 37 patients (26 men; mean age, 56.5 years). Simple closure with an omental patch by minilaparotomy (skin incision, ≤7 cm) was successful in 86.5% of the cases, with an operative mortality of 2.7%. Compared with the results in historic control patients who underwent conventional open surgery (n = 27), a shorter operative time (P < 0.01), lower frequency of analgesic use (P = 0.03), earlier passage of flatus (P < 0.01), and shorter hospital stay (P = 0.04) were obtained in the patients undergoing minilapartomoy. The postoperative morbidity was identical between the two groups (16.2% versus 33.3%, P = 0.40). On multivariate analysis, a large amount of intra-abdominal fluid was the only significant risk factor for extension of the minilaparotomy wound (P = 0.012). The minilaparotomy approach appears to be a feasible, safe, and less invasive approach compared with the conventional open approach and could be a useful alternative to the laparoscopic approach in selected patients with perforated duodenal ulcer.

Oncologic Outcome of Stages II/III Colon Cancer Treated via Minilaparotomy

We analyzed clinicopathologic, surgical, and survival data on consecutive series of patients with stages II/III colon cancer for whom curative resection via minilaparotomy (skin incision, ≤7 cm) was attempted between September 2002 and March 2009 to clarify the oncologic safety of this type of surgery. There were 64 men and 55 women; the median age was 70 years (range, 25–91 years). The median body mass index was 21.7 kg/m2 (range, 15.1–28.9 kg/m2). The minilaparotomy approach was successful in 115 cases (96.6%). The cumulative 5-year disease-free and overall survival rates were 89.7% and 82.4%, respectively, in patients with stage II disease (n = 62) and were 68.4% and 82.4%, respectively, in patients with stage III disease (n = 57), all of which were compatible with those of the historical control patients who underwent conventional open surgery. Minilaparotomy approach for stages II/III colon cancer seems to be oncologically equivalent to conventional open surgery.