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Left hepatic vein injury during laparoscopic antireflux surgery for large para-oesophageal hiatus hernia.

Nagpal AP, Soni H, Haribhakti SP - J Minim Access Surg (2009 Jul-Sep)

Bottom Line: Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach.Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications.The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Gastroenterology, Haribhakti Surgical Hospital, Ahmedabad, Gujarat - 380 006, India.

ABSTRACT
Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach. One such complication occurred in our patient who had intra-operative left hepatic vein injury during laparoscopic floppy Nissen fundoplication for large para-oesophageal rolling hernia. With timely conversion to open procedure, the bleeding was controlled and the antireflux and the procedure were completed uneventfully. However, this suggests that even with an experience in advanced laparoscopy surgery, complications can occur. Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications. The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures.

No MeSH data available.


Related in: MedlinePlus

Bleeding from the left hepatic vein
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Figure 0002: Bleeding from the left hepatic vein

Mentions: A 62-year-old male patient with no co-morbidities presented with complaints of fullness after meals since 3-4 months. Investigations were suggestive of large para-oesophageal hiatus hernia. Upper GI endoscopy was done which was suggestive of large para-oesophageal rolling type of hiatus hernia. A barium meal test was also done. The patient underwent a standard laparoscopic Nissen fundoplication for the repair of a hiatal hernia and correction of reflux. A Harmonic scalpel was used as the only energy source intra-operatively. The operation was commenced with the reduction of the large rolling hernia [Figure 1]. The lesser omentum (gastro hepatic ligament) was dissected. An aberrant left hepatic artery arising from the left gastric artery was encountered and secured. While dissecting to the right of GE junction, a small amount of bleeding was noted [Figure 2]. Injury to the left hepatic vein was suspected. After aspiration and careful inspection, a 1-2 mm vertical tear was found on the left hepatic vein. Attempt to control the bleeding from the tear was unsuccessful, as the bleeding became brisk [Figure 3]. The surgery was converted to an open procedure. At open surgery, the falciform ligament was divided and suprahepatic IVC was exposed. The left triangular ligament was divided and the left hepatic vein was exposed. Bleeding was controlled by suturing with 4-0 prolene. Later, the antireflux surgery was completed without further incident. The postoperative course was uneventful and the patient was discharged after 3 days.


Left hepatic vein injury during laparoscopic antireflux surgery for large para-oesophageal hiatus hernia.

Nagpal AP, Soni H, Haribhakti SP - J Minim Access Surg (2009 Jul-Sep)

Bleeding from the left hepatic vein
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822174&req=5

Figure 0002: Bleeding from the left hepatic vein
Mentions: A 62-year-old male patient with no co-morbidities presented with complaints of fullness after meals since 3-4 months. Investigations were suggestive of large para-oesophageal hiatus hernia. Upper GI endoscopy was done which was suggestive of large para-oesophageal rolling type of hiatus hernia. A barium meal test was also done. The patient underwent a standard laparoscopic Nissen fundoplication for the repair of a hiatal hernia and correction of reflux. A Harmonic scalpel was used as the only energy source intra-operatively. The operation was commenced with the reduction of the large rolling hernia [Figure 1]. The lesser omentum (gastro hepatic ligament) was dissected. An aberrant left hepatic artery arising from the left gastric artery was encountered and secured. While dissecting to the right of GE junction, a small amount of bleeding was noted [Figure 2]. Injury to the left hepatic vein was suspected. After aspiration and careful inspection, a 1-2 mm vertical tear was found on the left hepatic vein. Attempt to control the bleeding from the tear was unsuccessful, as the bleeding became brisk [Figure 3]. The surgery was converted to an open procedure. At open surgery, the falciform ligament was divided and suprahepatic IVC was exposed. The left triangular ligament was divided and the left hepatic vein was exposed. Bleeding was controlled by suturing with 4-0 prolene. Later, the antireflux surgery was completed without further incident. The postoperative course was uneventful and the patient was discharged after 3 days.

Bottom Line: Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach.Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications.The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Gastroenterology, Haribhakti Surgical Hospital, Ahmedabad, Gujarat - 380 006, India.

ABSTRACT
Although the advent of laparoscopic fundoplication has increased both patient and physician acceptance of antireflux surgery, it has become apparent that the laparoscopic approach is associated with an increased risk of some complications and as well as the occurrence of new complications specific to this approach. One such complication occurred in our patient who had intra-operative left hepatic vein injury during laparoscopic floppy Nissen fundoplication for large para-oesophageal rolling hernia. With timely conversion to open procedure, the bleeding was controlled and the antireflux and the procedure were completed uneventfully. However, this suggests that even with an experience in advanced laparoscopy surgery, complications can occur. Clear understanding of the normal and pathologic anatomy and its variations facilitates laparoscopic surgery and should help the surgeon avoid complications. The incidence of some of these complications decreases as surgeons gain experience; however, new complications can arise due to the increase in such procedures.

No MeSH data available.


Related in: MedlinePlus