OBJECTIVE: To examine the outcomes of surgery performed for bowel endometriosis including shaving, discoid resections with hand sewn closure, and segmental resection.
METHODS: Retrospective cohort study.
METHODS: Large academic hospital PATIENTS: All patients with bowel wall endometriosis who underwent surgical excision with the Division of Minimally Invasive Gynecologic Surgery (MIGS) between 2009 and 2022.
METHODS: No interventions administered.
RESULTS: From 2009 to 2022, a total of 112 patients underwent laparoscopic excision of endometriosis involving the rectum. From this cohort, 82 underwent shaving, 23 underwent discoid excision, and 7 had segmental bowel resection. The discoid excisions were closed in multiple layers with hand sewing and were not closed with a staple device. Average lesion size on preoperative imaging was 20.9 mm in the shave group, 22.5 mm in the discoid group and 38.5 mm in the segmental group. Complication requiring reoperation for anastomotic leak occurred in 3 cases (3.66%) of the shave group and 1 case (4.35%) of the discoid excision group, but did not occur in any of the segmental resections. The number of layers of closure and type of suture used did not appear to have an effect on complication rate, however this study was not powered to detect a meaningful difference.
CONCLUSIONS: Our data shows a similar rate of anastomotic leak complication for each closure type as that reported in the literature (2.2%, 9.7% and 9.9% reported for shave, discoid and segmental resection respectively). While our study is underpowered, these findings support that hand sewing for discoid excision is a safe and reasonable alternative to circular stapler closures and can be considered with an experienced surgeon. Further study is warranted to confirm safety and explore potential cost savings associated with this technique as well as applications in areas with less resources available.

Cesarean scar ectopic pregnancy is a leading cause of life-threatening complications in the first trimester. It poses a diagnostic and management challenge; if not diagnosed and adequately treated in early pregnancy, it may lead to considerable maternal morbidity and mortality. We report a case series of cesarean scar ectopic pregnancies managed successfully by laparoscopy. Laparoscopic excision is the gold standard management approach for cesarean scar ectopic pregnancy.

OBJECTIVE: To determine if laparoscopic excision is more effective than open excision in the treatment of choledochal cysts.
METHODS: A systematic review of randomized clinical trials in 3 databases measuring the efficacy of laparoscopic and open excision of choledochal cysts was performed. The authors considered international and national reports, whose results were analyzed in detail.
RESULTS: Mean duration of laparoscopic excision was 51 min, open excision - 35.4 min. Length of hospital-stay after laparoscopic excision ranged between 5 and 74 days, after open excision - between 7 and 146 days. Bile leakage rate was 1-2% and 4%, respectively. Laparoscopic excision was followed by lower complication rate. Morbidity and mortality in laparoscopic excision was 20% and 0%, in open excision - 60% and 3.3%, respectively.
CONCLUSIONS: Laparoscopic excision is more effective than open excision in the treatment of choledochal cysts.
UNASSIGNED: Сравнить эффективность лапароскопического и открытого хирургического лечения кист холедоха.
UNASSIGNED: Проведен систематический обзор рандомизированных клинических исследований в 3 базах данных, оценивающих эффективность лапароскопического и открытого иссечения кист холедоха. Авторы рассмотрели международные и национальные отчеты, результаты которых были подробно проанализированы.
UNASSIGNED: Средняя продолжительность лапароскопического вмешательства составила 51 мин, открытого — 35,4 мин. Продолжительность пребывания в стационаре после операции колебалась от 5 до 74 и от 7 до 146 сут соответственно. Частота желчеистечения составила 1—2% и 4% соответственно. Лапароскопическое иссечение сопровождалось меньшим количеством осложнений. Частота осложнений и смертность при лапароскопическом лечении составили 20% и 0%, при открытой операции — 60% и 3,3% соответственно.
UNASSIGNED: Лапароскопическое иссечение более эффективно у больных с кистами холедоха.

Castleman disease is a rare and benign disorder, characterized by enlarged lymph nodes and angiofollicular lymphoid hyperplasia. We report a case of a 57-year-old male, who was admitted to our surgical department because of a retroperitoneal nodular mass measuring about 4 cm in maximum diameter, incidentally discovered on a radiologic exam performed for the onset of vague abdominal pain with posterior irradiation. The patient was subdue to laparoscopic removal of the mass and no intra- and post-operative complications were recorded. Histologic diagnosis of hyaline-vascular variant of the Castleman disease was confirmed. Only two cases have been found in the literature reporting the paraduodenal unicentric Castleman disease localization like our case. Although rare, the Castleman disease must be considered in the differential diagnosis among all the lymph nodes diseases, for avoiding improper therapies.

Accessory cavitated uterine mass (ACUM) is a rare form of developmental mullerian anomaly which causes chronic pelvic pain, dysmenorrhea and infertility in young females. It is a non-communicating, accessory cavity within an otherwise normal uterus, lined by functional endometrium and surrounded by myometrium-like smooth muscle cells which imparts it uterus-like appearance. USG and MRI are the imaging modalities which help in reaching the diagnosis. Knowledge of this entity and awareness of its imaging features can help diagnose this often underdiagnosed and surgically correctable cause of dysmenorrhea.

Schwannoma is a benign tumor of the nerve sheath originating from Schwann cells. The tumor rarely occurs in the sciatic nerve. The patient in the present case report was a 58-year-old woman presenting with pain in the right hip and leg, as well as numbness of the right lower limb. Magnetic resonance imaging revealed a solid tumor of 2.9 cm in diameter in the right pelvic space. The mass was considered to be a neurogenic tumor originating from the right sciatic nerve. Total laparoscopic surgery was performed to safely separate the tumor from the surrounding tissues, with preservation of the right sciatic nerve. The pathological result suggested a schwannoma. The patient recovered well with a transient numbness in the right heel. The laparoscopic approach used for this intrapelvic schwannoma of the sciatic nerve was safe and feasible, with the advantages of a magnified surgical field and small skin incision. However, the specific surgical approach should be based on the detailed condition of each patient and the experience of the surgeon with regard to laparoscopic surgery on benign presacral tumors and rectal tumors.

BACKGROUND: Laparoscopic excision of endometrioma and subsequent hemostasis have detrimental effects on ovarian reserve.
OBJECTIVE: To evaluate which hemostatic approach after stripping cystectomy shows less damage on ovarian reserve.
METHODS: Embase, MEDLINE, Scopus, Scielo.br, LILACS, Cochrane Library at the CENTRAL Register of Controlled Trials, Clinicaltrials.gov, CINAHL, conference abstracts, and International Clinical Trials Registry Platform were searched from inception until April 2022.
METHODS: Randomized controlled trials of women undergoing laparoscopic endometrioma excision that compared at least two hemostatic approaches.
METHODS: Relevant data were extracted and tabulated. Network meta-analysis based on random-effects model for mixed multiple treatment to rank hemostatic strategies using the surface under the cumulative ranking curve area (SUCRA) was performed. Quality assessment was performed using Cochrane criteria. The primary outcome was serum antimullerian hormone levels 3 months after surgery.
RESULTS: Ten studies, including 748 women, were selected. Suturing the ovary with barbed suture (SUCRA, 82.80%) seem the most effective strategy to avoid antimullerian hormone reduction. Similarly, for ultrasonographic antral follicular count, barbed (SUCRA, 30.70%) and simple suture (SUCRA, 30.70%) were ranked the best choices. Ovarian suturing with simple suture demonstrated lower follicle-stimulating hormone levels (SUCRA, 88.70%).
CONCLUSIONS: Suturing the ovary, with simple or barbed suture, seems the most effective approach to keep ovarian reserve higher.

BACKGROUND: Simple hepatic cysts are common lesions in adults, but rare in children. Because of their benign nature, simple hepatic cysts may not be detected until they grow too large to be diagnosed and resected in a minimally invasive manner.
METHODS: An 18-month-old girl presented with an enormous cyst occupying the entire abdomen. The beak sign on computed tomography revealed the hepatic origin of the cyst. The cyst was decompressed through the umbilicus, which was opened by the three-triangular-skin-flap technique, thus creating a working space that enabled laparoscopic surgery. The cyst was excised en bloc together with the attached hepatic parenchyma.
CONCLUSIONS: Giant simple hepatic cysts occupying the entire abdomen are rare in children. Of 14 reported cases, only 1 underwent laparoscopic treatment. We have herein reported another case of a giant simple hepatic cyst in which the beak sign on imaging and the three-triangular-skin-flap umbilical opening technique were useful for its diagnosis and laparoscopic excision, respectively. Complete excision is desirable because there is a possibility of recurrence or other diseases that require total removal, including hydatid cysts and mesenchymal hamartomas.

BACKGROUND: The incidence of retrorectal lesions is low, and no consensus has been reached regarding the most optimal surgical approach. Laparoscopic approach has the advantage of minimally invasive. The risk factors influencing perioperative complications of laparoscopic surgery are rarely discussed.
OBJECTIVE: To investigate the risk factors for perioperative complications in laparoscopic surgeries of retrorectal cystic lesions.
METHODS: We retrospectively reviewed the medical records of patients who underwent laparoscopic excision of retrorectal cystic lesions between August 2012 and May 2020 at our hospital. All surgeries were performed in the general surgery department. Patients were divided into groups based on the lesion location and diameter. We analysed the risk factors like type 2 diabetes mellitus, hypertension, the history of abdominal surgery, previous treatment, clinical manifestation, operation duration, blood loss, perioperative complications, and readmission rate within 90 d retrospectively.
RESULTS: Severe perioperative complications occurred in seven patients. Prophylactic transverse colostomy was performed in four patients with suspected rectal injury. Two patients underwent puncture drainage due to postoperative pelvic infection. One patient underwent debridement in the operating room due to incision infection. The massive-lesion group had a significantly longer surgery duration, higher blood loss, higher incidence of perioperative complications, and higher readmission rate within 90 d (P < 0.05). Univariate analysis, multivariate analysis, and logistic regression showed that lesion diameter was an independent risk factor for the development of perioperative complications in patients who underwent laparoscopic excision of retrorectal cystic lesions.
CONCLUSIONS: The diameter of the lesion is an independent risk factor for perioperative complications in patients who undergo laparoscopic excision of retrorectal cystic lesions. The location of the lesion was not a determining factor of the surgical approach. Laparoscopic surgery is minimally invasive, high-resolution, and flexible, and its use in retrorectal cystic lesions is safe and feasible, also for lesions below the S3 level.

BACKGROUND: Accessory and cavitated uterine mass (ACUM) is an uncommon form of connate Müllerian anomaly seen in young and nulliparous women, which presents as chronic periodic pelvic pain and severe dysmenorrhea. The entity is often underdiagnosed due to a broad differential diagnosis, including rudimentary uterine horn, true cavitated adenomyosis and degenerating fibroids.
METHODS: A 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with cystic adenomyosis. Gynecological examination and ultrasonography were performed. The patient underwent laparoscopic excision of the mass and histopathological examination confirmed the diagnosis. Postoperatively, the patient did well, with no further dysmenorrhea.
CONCLUSIONS: ACUM is difficult to diagnose. A correct diagnosis can be made only after excision and histopathological evaluation. Surgical excision is necessary and can be carried out by laparoscopy.