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ABSTRACT: Enteric duplication cysts and reversed intestinal rotation (RIR) are rare congenital anomalies, with their coexistence being exceptionally uncommon. We report a 4-year-old girl who presented with chronic anemia and intermittent abdominal symptoms since infancy. Detailed workup for medical causes of anemia was inconclusive. Computed tomography of the abdomen revealed intestinal malrotation with a grossly dilated small bowel loop. Intraoperative findings revealed a long duodenojejunal tubular duplication with a separate mesentery (Type 1a) and RIR. The patient underwent a Ladd's procedure, resection of the duplication cyst, and end-to-end anastomosis. This case underscores the anatomical rarity, varied clinical presentation, and challenges in making an accurate and timely diagnosis in such a case. [ABSTRACT FROM AUTHOR]

Background: Blunt bowel and mesenteric injuries (BBMI) are frequently missed despite the widespread use of computed tomography (CT). Early diagnosis for timely management of surgically significant blunt bowel and mesenteric injuries (sBBMI) can be challenging. Several tools predictive for sBBMI have been proposed such as the "Bowel Injury Prediction Score" (BIPS) that is based on presence of abdominal tenderness, white blood cell count ≥17,000/mm3 and CT grade. The utility of this scoring system for early diagnosis of sBBMI has neither been studied in an Indian population nor prospectively validated. Methods: A single-centre prospective cohort study was conducted at a Trauma Centre in India. After screening of 1793 patients with blunt trauma abdomen who presented between 1st January 2022 and 31st August 2022 and underwent CT scan, eventually, 80 patients of age >18 years, hemodynamically stable and CT finding suspicious of BBMI were included. BIPS score was calculated. Patients were followed to evaluate the outcome. Results: The incidence of sBBMI was 3.06%. Mean age of study patients was 36.2 ± 16.5 years with male predominance (92.5%) and road traffic accidents the commonest mode of injury. Patients with BBMI were more likely to require operative intervention in the presence of abdominal tenderness at presentation (p < 0.01) and CT grade ≥4 (p < 0.01). For patients with WBC counts of ≥17,000/mm3, no statistically significant difference was noted in the need for operative intervention. BIPS ≥2 had 94.5% sensitivity, 72% specificity, 88% PPV, and 86% NPV for identifying patients with sBBMI. Conclusion: Calculation of BIPS at the time of presentation can avoid unnecessary delays in surgical management and thereby reduce overall morbidity and mortality even in an Indian setup. However, WBC counts > 17,000/mm3 were not found to be predictive of sBBMI. [ABSTRACT FROM AUTHOR]

Since the early1990s, laparoscopic right colon resections have been the most performed advanced laparoscopic procedures just after laparoscopic left colectomies and sigmoid resections. Indications for laparoscopic right colectomies are either benign or malignant diseases. Despite its many indications, a laparoscopic right or extended right colectomy is mostly performed for cancer of the caecum, the ascending colon, the hepatic flexure or the proximal transverse colon. Worldwide, colorectal cancer is the third most diagnosed cancer: an estimated 1,880,725 people were diagnosed with colorectal cancer in 2020, out of which 1,148,515 were colon cancer cases and 40% were located in the right colon. These figures make an oncologic sound surgery for right colon cancer of the utmost relevance. More recently, complete mesocolic excision has been advocated as the optimal choice in term of radicality, especially in node-positive patients with right colon cancer. Laparoscopic standard right colectomy and extended right colectomy with or without CME should be performed according to defined principles based on a close knowledge of key anatomical landmarks. This knowledge will allow to trace anatomical structures and drive instruments along the correct surgical planes and has its foundations in teachings from surgeons and scientists of past and present time. [ABSTRACT FROM AUTHOR]

Background: Colon cancer is a disease with a worldwide spread. Surgery is the best option for the treatment of advanced colon cancer, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines, the gold standard was D3 dissection to remove the central lymph nodes (203, 213, and 223), but in 2009, Hoenberger et al. introduced the concept of complete mesocolic excision, in which surgical dissection follows the embryological planes to remove the mesentery entirely to prevent leakage of cancer cells and collect more lymph nodes. Our study describes how lymphadenectomy is currently performed in major Italian centers with an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). Methods: CoDIG 2 is an observational multicenter national study that involves 76 Italian general surgery wards highly specialized in colorectal surgery. Each center was asked not to modify their usual surgical and clinical practices. The aim of the study was to assess the preference of Italian surgeons on the type of lymphadenectomy to perform during RH and the rise of any new trends or modifications in habits compared to the findings of the CoDIG 1 study conducted 4 years ago. Results: A total of 788 patients were enrolled. The most commonly used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%), side-to-side (98.7%), or isoperistaltic (96.0%) anastomosis. The lymph nodes at the origin of the vessels were harvested in an inferior number of cases (203, 213, and 223: 42.4%, 31.1%, and 20.3%, respectively). A comparison between CoDIG 1 and CoDIG 2 showed a stable trend in surgical techniques and complications, with an increase in the robotic approach (7.7% vs. 12.3%). Conclusions: This analysis shows how lymphadenectomy is performed in Italy to achieve oncological outcomes in RH, although the technique to achieve a higher lymph node count has not yet been standardized. Trial registration (ClinicalTrials.gov) ID: NCT05943951. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mesenteric cysts are rare, usually asymptomatic intra-abdominal benign cystic lesions, located in gastrointestinal tract mesentery. Their incidence is estimated about 1/20,000 in the pediatric age group with a male-to-female ratio of 1:2. Here, we report a case of ileal chylolymphatic mesenteric cyst in a 4-year-old male child. A 4-year-old male child presented to the outpatient department with a history of on-and-off abdominal pain and vomiting for the last 2 years. Ultrasound revealed a well-defined anechoic area measuring approximately 68 mm x 52 mm in the lower abdomen and pelvis. Exploratory laparotomy was performed and excised cyst with an attached part of the ileum was sent for histopathology. Correlating histology with immunohistochemical findings, the final diagnosis of ileal chylolymphatic type mesenteric cyst was considered. Mesenteric cysts should be kept as a differential diagnosis of intra-abdominal and pelvic cystic lesions. Although rare, awareness of this entity is necessary for early and prompt diagnosis as well as management, particularly in patients of the pediatric age group. [ABSTRACT FROM AUTHOR]

Copyright of QhaliKay: Revista de Ciencias de la Salud is the property of QhaliKay Revista de Ciencias de la Salud and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Intestinal malrotation is a congenital anomaly resulting from abnormal or incomplete rotation and fixation of the midgut during embryogenesis. It commonly presents in the neonatal period (75%) with sudden onset bilious vomiting and rarely beyond infancy (<10%). Aim: The aim of the study was to highlight the clinical features, radiological findings, and treatment outcomes of patients with malrotation presenting beyond infancy. Materials and Methods: Eleven consecutive cases of delayed presentation of malrotation presented over a period of 5 years (2017-2021). Data were analyzed retrospectively. Results: Out of the 11 patients, four were female and seven were male. The age of patients ranged from 14 months to 18 years. Patients beyond infancy present usually with diffuse pain abdomen compared to neonates which present with sudden onset bilious vomiting and therefore difficult to diagnose. Five patients had associated abnormalities such as intussusception or nutcracker syndrome or mesenteric cyst or jejunal stricture or mesenteric lymphadenopathy along with malrotation. Patients underwent ultrasonography, upper gastrointestinal contrast study, and contrast-enhanced computed tomography abdomen to confirm the diagnosis. All patients underwent the Ladd procedure with four requiring resection anastomosis and one requiring excision of the mesenteric cyst. Eight out of eleven patients had favorable outcomes, two develop adhesive intestinal obstruction and required re-exploration, and one had persistent complaints of hematochezia. Conclusion: Malrotation beyond infancy is a rare diagnosis. Malrotation in older children is usually not suspected because of the wide range of symptoms. A high index of suspicion on ultrasound or computed tomography is required to demonstrate the reversal of superior mesenteric artery and superior mesenteric vein position and related conditions. Early intervention and treatment can prevent catastrophic events such as intestinal volvulus and intestinal ischemia in these patients. [ABSTRACT FROM AUTHOR]

Although right gastric artery ligation is efficient to enhance a lower-tension anastomosis, still in severe intra-abdominal adiposity, antecolic approach may not provide sufficient length for a safe duodenoenterostomy anastomosis. Combining right gastric artery ligation with trans-mesocolic pull-through overcomes the thick mass of the transverse colon to achieve low-tension anastomosis. Trans-mesocolic pull-through operative technique was performed in duodenal switch, duodenojejunal bypass, and single anastomosis duodenoileal bypass with sleeve gastrectomy procedures. Demographic data, body mass index, operation time, perioperative, and postoperative complications were analyzed. A total of 70 patients were included in the study between January 2013 to December 2016. The male/female ratio was 0.4 (male/female: 20/50). The mean age was 41.1 years (age:18–67). A total of 28 patients had single anastomosis duodenoileal bypass with sleeve gastrectomy, 34 had duodenal switch, and 8 had duodenojejunal bypass operations. The mean BMI was 51.9 kg/m2 (35–64), mean duration of surgery was 232.9 min (134–346), and mean hospital stay was 5.2 days (3–9). No early or late postoperative mortality was observed. The overall complication rate related with operative technique was 4.3% (n:3) including post-pyloric duodenal necrosis, duodenal stump fistula, and intra-abdominal abscess. A total of 67 patients were discharged uneventfully with a follow-up of mean of 75.9 (52–96) months in term. The current paper put into a modified approach with right gastric artery ligation and pull-through of the gastric sleeve and may be a safe technique in short and thick mesentery patients for a low-tension anastomosis. [ABSTRACT FROM AUTHOR]

Background: There are different causes of Incidental Enlarged MesentericLlymph Nodes (IMLN) found during laparotomy, which most of the time influence the postoperative course. These causes are variable across the globe, but the node pattern in our locality and the factors associated with the incidental enlarged mesenteric lymph nodes are not yet established. Due to the lack of an established protocol in our locality, there have been some mismanaged cases that led to several postoperative complications. Therefore, this study aimed to evaluate the prevalence, factors associated with, and histological pattern of incidental mesenteric lymphadenopathy., Methodology: The 885 patients were conveniently recruited in the study. The incidental enlarged mesenteric lymph nodes were taken during surgery, processed and histologically analyzed as per pathological protocol. Obtained data were filled out and analyzed using SPSS version 27. Binary logistic regression was used to examine clinical data, with a significance level of p < 0.05, to determine the factors linked to lymph node enlargement., Results: It was seen that 58.08% of the study group, with a mean age of 30.5 years, were between the ages of 21 and 40. Males accounted for 71.53% of the total, while 252 individuals were female, giving a M: F ratio of 2.5:1. The prevalence of incidental mesenteric lymphadenopathy was 12.5%. Associated factors of Incidental Mesenteric Lymphadenopathy in this study were HIV, smoking, nomadic pastoralism, and surgical indication. HIV-positive patients were 7 times more likely to have IML with a 95% CI [2.975, 16.741], and (p < .0001), smokers were 10 times more likely to have IMLN, 95% CI [3.745, 28.458], and (p < .0001), nomadic pastoralists were 3 times more likely to have IMLN, 95% CI [1.647, 5.882], and (p < .0001) and patients who were operated upon peritonitis were 3 times more likely to have IMLN, 95% CI [2.040, 7.572], and (p < .0001). Of the incidental lymphadenopathy (N = 111), 23.42% had granulomatous tuberculous lesions, and 9.01% of lymph nodes harbored malignancy. About 47% of patients had histologically confirmed reactive lymph nodes, while 20.72% had an inflammatory pattern. CONCLUSION AND RECOMMENDATION: The major factors associated with incidental enlarged mesenteric lymph nodes are smoking, comorbidities such as HIV and diabetes, malignancies, and infections such as tuberculosis. The common histological pattern is reactive nodes though there are potentially fatal nodes that were discovered including those that harbored malignancies and infections such as Tuberculosis. Therefore, to rule out potentially fatal illnesses and comorbidities that can be treated early to spare patients from extended hospital stays and potentially disastrous results, comprehensive investigations should be conducted in the event of incidentally enlarged mesenteric lymph nodes are found during a laparotomy., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was obtained from The Dodoma University Research Review Ethics Committee (Ref. No. MA. 84/261/73/22). All participants who accepted to be recruited in the study signed a written consent form. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

In recent years, with the deepening of mesentery research, it is found that its blood vessels, nerves, lymphoid tissue, adipose tissue and other structures play an important role in the occurrence and development of Crohn disease, and the degree of lesion is related with the disease process, surgical difficulty, the occurrence of intraoperative complications and postoperative recurrence. The optimal surgical strategy of Crohn disease based on mesenteric involvement has received great attention. Multiple retrospective studies found that extended mesenteric resection and Kono-S anastomosis potentially could reduce the rate of postoperative recurrence. However, the latest prospective randomized controlled studies did not achieve the expected results, and the evidence for the surgical strategy based on mesentery is still weak. This review summarises the findings of basic and clinical investigations of the mesentery in Crohn disease so far and explores its role in surgical treatment optimization, and provides new thinking and insights for the further research and surgical options for Crohn disease.

Background: Extraskeletal osteosarcoma (ESOS) is a rare kind of sarcoma with a low preoperative diagnosis and a poor prognosis. ESOS arising from abdominal mesentery is extremely rare. Increasing diagnostic methods and standardizing treatment protocols are crucial issues of ESOS., Case Presentation: We report the case of a 52-year-old female ESOS patient. She had a history of ovarian carcinoma (stage IIIC) surgery two years before, with five cycles of chemotherapy. A mass was found during postoperative examinations. A R0 surgical resection was performed. Post-operational pathological report plus intra-surgery findings supported a diagnosis of ESOS. She is still alive 10 months post-operationally, with routine blood and radiographical examinations., Conclusion: Enhancing awareness of this extremely rare disease together with advancements in diagnostic methods will hopefully enable earlier recognition and initiation of treatment. Protocols for standardizing treatments require a larger multi-center collaboration and more data analysis., Competing Interests: Declarations. Ethics approval and consent to participate: The authors certify that they obtained all appropriate patient consent forms. They were assured that the patient’s names and initials would not be published and due efforts would be made to conceal the identity of the patient, although anonymity could not be guaranteed. Consent for publication: We got the consent of the patient and family members before using the patient’s data in this study. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

We present the case of a man in his 60s with hypertension, who had a 3-year history of an irreducible mass in the left inguinal area. The patient presented at the emergency room with left lower quadrant pain and scrotal pain. The clinical examination was not suggestive of an acute abdomen. A CT scan was done showing an anterior abdominal wall defect at the left inguinal region. The patient underwent exploratory laparotomy, ileal resection and anastomosis, mesh hernioplasty left for the mesenteric fibromatosis mass mimicking as an irreducible inguinal hernia. Histopathology and immunohistochemistry showed desmoid-type fibromatosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a rare and highly malignant primary tumor characterized by the loss of SMARCA4 expression. Despite advancements in oncology, diagnosing and treating SMARCA4-UT remain significant clinical challenges., Case Demonstration: A 67-year-old male with a history of smoking presented to the hospital with complaints of abdominal distention and pain lasting for more than four days. Abdominal computed tomography (CT) revealed a high-density mass measuring approximately 41 × 37 mm in the right lower quadrant. Additionally, chest CT identified a high-density mass measuring 63 × 48 mm in the upper lobe of the right lung. The patient underwent partial small bowel resection, and postoperative pathological examination confirmed a diagnosis of SMARCA4-UT originating in the small mesentery. Unfortunately, the patient succumbed to respiratory failure 21 days after the diagnosis., Conclusion: SMARCA4-UT is an exceedingly rare and aggressive undifferentiated tumor. This case highlights a presentation of SMARCA4-UT with abdominal pain and distention as initial symptoms. Clinicians should consider SMARCA4-UT in middle-aged or elderly male patients with a history of smoking who present with large masses. Comprehensive chest imaging is essential to exclude the thoracic primary disease in such cases., Competing Interests: Declarations. Ethics approval and consent to participate: This case report was approved by the Ethics Committee of the Affiliated Hospital of Zunyi Medical University. Written informed consent was obtained from the patient and the patient’s family for publication of this clinical case report. Consent for publication: Written informed consent was obtained from the patient and the patient’s family for publication of this case report and any accompanying images. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

We report the case of an 87-year-old woman with a long-term prognosis after resection of a recurrent mesenteric liposarcoma. She was diagnosed with mesenteric tumor and rectal cancer and underwent simultaneous resection. Postoperative pathological examination revealed Stage Ⅰ rectal cancer and the mesenteric tumor was found to be a liposarcoma with a mixture of dedifferentiated and well-differentiated types. A CT scan during follow-up showed a local recurrence of mesenteric liposarcoma. Thirty months after the initial surgery, the recurrent tumor was resected. Postoperative pathology showed positive margins with a diagnosis of only well-differentiated liposarcoma. Chemotherapy was not administered, but there was no evidence of recurrence 52 months after surgery. We considered that positive resection margins of well-differentiated liposarcoma in elderly patients suggested that strict follow-up may be acceptable.

The case was a 75-year-old man. The patient had back pain and an abdominal CT scan was performed. The scan revealed an 8 cm mass in the left lower abdomen, containing both fatty and solid components. An abdominal MRI showed the mass had shifted position, with the solid component exhibiting high signal intensity on diffusion-weighted imaging, suggesting a liposarcoma originating from the small bowel mesentery. For diagnosis and treatment, laparoscopic-assisted surgery was performed. Laparoscopic observation revealed a mobile mass within the jejunal mesentery, and a small laparotomy was conducted to remove it. Histologically, the tumor was identified as a liposarcoma with both well-differentiated and dedifferentiated components. There was no recurrence for 6 years after the surgery.

Background: Characteristics and prognoses of lateral lymph node (LLN) metastasis but not mesenteric lymph node (LN) metastasis are poorly understood. This study explored patterns of mesenteric and LLN metastases in rectal cancer patients., Method: This retrospective, multicentre study was conducted at three institutions and included patients who underwent total mesorectal excision (TME) with lateral lymph node dissection (LLND) for rectal cancer (n = 271)., Results: Among the patients with LLN metastases, 210 patients (77.5 %) with clinical stage T3-4 disease and 157 patients (57.9 %) with clinical stage N1-N2 disease underwent TME as well as LLND. The prognoses of patients with metastasis confined to LLNs were significantly better than those of patients with both mesenteric and LLN metastases (3-year overall survival: 85.0 % vs. 51.0 %, p = 0.005; 3-year disease-free survival: 75.0 % vs. 26.5 %, p = 0.003) and were similar to those of patients with metastasis confined to mesenteric LNs (3-year overall survival: 85.0 % vs. 83.8 %, p = 0.607; 3-year disease-free survival 75.0 % vs. 68.8 %, p = 0.717). Patients with metastases confined to LLN had a lower proportion of poor histological types (20.0 % vs. 65.3 %, p = 0.002), lymphatic invasion (20.0 % vs. 59.2 %, p = 0.036) and number of LLN metastases (1.6 vs 2.7, p = 0.004), and all metastases were confined to the internal iliac or obturator region (100.0 % vs. 77.6 %, p = 0.008) compared to patients with both mesenteric and LLN metastasis., Conclusions: Approximately a quarter of patients with rectal cancer have LLN metastases but no mesenteric LN metastases. These patients have favourable pathological features and prognoses and can be managed and treated for mesenteric LN metastasis., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

BACKGROUND: Previous studies on how complete mesocolic excision (CME) affects prognosis indicate fundamental limitations that prevent the procedure from being completely accepted in practice. This study evaluated 5-year survival in colon cancer patients who underwent CME in a strict quality-controlled trial. STUDY DESIGN: A prospective, nonrandomized, double-blind, controlled trial recruited patients who underwent open radical resection for colon cancer between November 2012 and November 2017. Third-party experts evaluated whether patients had undergone mesocolic dissection and/or central ligation by looking at photographs of both surgical field and specimen, and then divided patients into CME and non-CME (NCME) groups. The primary outcome was the 5-year local recurrence-free survival rate. Clinicopathological and follow-up data were recorded. RESULTS: There were 261 patients with a median follow-up time of 57 months assigned to the CME group, and 129 patients with a median follow-up time of 59 months were assigned to the NCME group. The 5-year local recurrence-free survival rate of patients with Union Internationale Contre le Cancer stage I to III cancer did not differ significantly between the groups. For stage I to III cancer and stage III cancer, the absolute risk reduction of 5-year cumulative death and disease progression after CME were 9.1% (95% CI 1% to 17%; p = 0.033) and 16.1% (95% CI 1% to 31%; p = 0.040), respectively. Meanwhile, CME also could reduce 14% 5-year cumulative incidence recurrence for Union Internationale Contre le Cancer stage III cancer compared with NCME (CME, 27.3% vs NCME, 41.3%; p = 0.042) after adjusting for the effect of non-cancer-related death. CONCLUSIONS: CME should be considered as a standard surgical procedure in affected patients. [ABSTRACT FROM AUTHOR]

Aims: Complete mesocolic excision (CME) has been proposed as a way to improve the oncological outcomes in patients with colon cancer. To investigate whether there is rationale for adopting the technique in Scotland, our aim was to define the incidence of disease recurrence following standard right hemicolectomy and to compare this with published CME outcomes.Methods: Data was collected on consecutive patients undergoing right or extended right hemicolectomy for colonic adenocarcinoma (2012-2017) at three hospitals in Scotland (Raigmore Hospital, Aberdeen Royal Infirmary and Glasgow Royal Infirmary). Emergency or palliative surgery was excluded. Patients were followed up with CT scans and colonoscopy for a minimum of 3 years.Results: 689 patients (M 340, F 349) were included. 30-day mortality was 1.6%. Final pathological stage was Stage I (14%), Stage II (49.8%) and Stage III (36.1%). During follow-up, 10.5% developed loco-regional recurrence and 12.2% developed distant metastases. The 1, 3 and 5-year disease-free survival (DFS) was 94%, 84% and 82% respectively. Primary determinants of recurrence were T stage (p < 0.001), N stage (p < 0.001), apical node involvement (p < 0.001) and EMVI (p < 0.001). When compared to the literature, 30-day mortality was lower than many published series and DFS rates were similar to the largest CME study to date (4 year DFS 85.8% versus 83%).Conclusion: The outcomes of patients undergoing right hemicolectomy in Scotland compare favourably with many published CME studies. The technique demands further evaluation before it can be recommended for adoption into routine surgical practice. [ABSTRACT FROM AUTHOR]

Background: The correct extent of mesocolic dissection for right-sided colon cancer (RCC) is still under debate. Complete mesocolic excision (CME) has not gained wide diffusion, mainly due to its technical complexity and unclear oncological superiority. This study aims to evaluate oncological outcomes of CME compared with non-complete mesocolic excision (NCME) during resection for I-III stage RCC.Method: Prospectively collected data of patients who underwent surgery between 2010 and 2018 were retrospectively analysed. 1:1 Propensity score matching (PSM) was used to balance baseline characteristics of CME and NCME patients. The primary endpoint of the study was local recurrence-free survival (LRFS). The two groups were also compared in terms of short-term outcomes, distant recurrence-free survival, disease-free survival, and overall survival.Results: Of the 444 patients included in the study, 292 were correctly matched after PSM, 146 in each group. The median follow-up was 45 months (IQR 33-63). Conversion rate, complications, and 90-day mortality were comparable in both groups. The median number of lymph nodes harvested was higher in CME patients (23 vs 19, p = 0.034). 3-year LRFS rates for CME patients was 100% and 95.6% for NCME (log-rank p = 0.028). At 3 years, there were no differences between the groups in terms of overall survival, distant recurrence-free survival, and disease-free survival.Conclusion: Our PSM cohort study shows that CME is safe, provides a higher number of lymph nodes harvested, and is associated with better local recurrence-free survival. [ABSTRACT FROM AUTHOR]

Background: CME is a radical resection for colon cancer, but the procedure is technically demanding with significant variation in its practice. A standardised approach to the optimal technique and training is, therefore, desirable to minimise technical hazards and facilitate safe dissemination. The aim is to develop an expert consensus on the optimal technique for Complete Mesocolic Excision (CME) for right-sided and transverse colon cancer to guide safe implementation and training pathways.Methods: Guidance was developed following a modified Delphi process to draw consensus from 55 international experts in CME and surgical education representing 18 countries. Domain topics were formulated and subdivided into questions pertinent to different aspects of CME practice. A three-round Delphi voting on 25 statements based on the specific questions and 70% agreement was considered as consensus.Results: Twenty-three recommendations for CME procedure were agreed on, describing the technique and optimal training pathway. CME is recommended as the standard of care resection for locally advanced colon cancer. The essential components are central vascular ligation, exposure of the superior mesenteric vein and excision of an intact mesocolon. Key anatomical landmarks to perform a safe CME dissection include identification of the ileocolic pedicle, superior mesenteric vein and root of the mesocolon. A proficiency-based multimodal training curriculum for CME was proposed including a formal proctorship programme.Conclusions: Consensus on standardisation of technique and training framework for complete mesocolic excision was agreed upon by a panel of experts to guide current practice and provide a quality control framework for future studies. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the feasibility and advantages of wedge resection plus transverse suture without mesentery detached approach applied to loop ileostomy closure by analyzing the surgical data and the incidence of postoperative complications of patients undergoing this procedure.Methods: We performed a retrospective analysis of the hospitalization data of patients who underwent ileostomy closure surgery and met the research standards from January 2017 to April 2021 in Guangxi Medical University Cancer Hospital; all surgeries were performed by the same surgeon. The perioperative data were statistically analyzed by grouping.Results: In total, 65 patients were enrolled in this study, with 12 in the wedge resection group, 35 in the stapler group, and 18 in the hand suture group. There was no significant difference in operation time between the wedge resection group and stapler group (P > 0.05), but both groups had shorter operation time than that in the hand suture group (P < 0.05). The postoperative exhaustion time of wedge resection group was earlier than that of the others, and cost of surgical consumables in the wedge resection group was significantly lower than that in the stapler group, all with statistically significant differences (P < 0.05). By contrast, there were no statistically significant differences in postoperative complication incidences among the three groups.Conclusions: The wedge resection plus transverse suture without mesentery detached approach is safe and easy for closure of loop ileostomy in selected patients, and the intestinal motility recovers rapidly postoperatively. It costs less surgical consumables, and is particularly suitable for the currently implemented Diagnosis-Related Groups payment method. [ABSTRACT FROM AUTHOR]

This case report describes a woman in her late 50s with mesenteric volvulus, an uncommon and potentially fatal condition. She developed excessive abdominal distension, nausea and vomiting for a duration of 2 days. The preliminary ultrasound indicated a large, thick-walled, tight fluid region in her upper abdomen, indicating a probable gastric outlet obstruction. A subsequent contrast-enhanced CT scan of the abdomen confirmed the diagnosis, showing significant distension of the stomach with a thick septum displacing adjacent organs. The mesenteric volvulus was surgically treated as an emergency to restore blood flow to the afflicted mesentery. This condition poses a serious concern due to decreased blood flow and ischaemia, and this example emphasises the necessity of a CT scan for early and precise diagnosis and offers a comprehensive insight into the nature of the volvulus, resulting in prompt surgical treatment and improved patient outcome., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Free jejunal transfer is one of the most useful procedures for reconstructing circumferential defects following total pharyngolaryngoesophagectomy (TPLE). When an extended resection of the surrounding soft tissue is performed in addition to the TPLE, the defect may require another flap in addition to the jejunal flap to reconstruct the soft tissue defect. In such multiple defects, the choice of reconstruction method remains unanswered and unsolved. Herein, our objective was to clarify the utility of our newly developed technique of simultaneous reconstruction of two defects in the neck using a combination of free jejunal and mesenteric flaps. An 81-year-old man had defects in the upper esophagus, total larynx/pharynx, and posterior tracheal wall caused by the resection of invasive upper esophagus cancer anterior to the membranous part of the trachea. A chimera flap composed of a 15 cm free jejunal and mesenteric flap along with 15 cm of surplus mesentery was harvested; the jejunum was inserted into the esophageal defect and the mesentery was placed on the tracheal defect. The patient exhibited a favorable postoperative course at 8 months with no recurrence or stenosis in the reconstructed respiratory or gastrointestinal tract. This method offers a straightforward vessel anastomosis, making it a good and reasonable option for reconstructing partial tracheal defects along with TPLE., (© 2024 Wiley Periodicals LLC.)

Background: Very few risk factors for postoperative recurrence (POR) of Crohn's Disease (CD) after ileocecal resection have been identified. The aim of the present study was to verify the association between an a priori defined list of intraoperative macroscopic findings and POR., Methods: This was a prospective observational study including patients undergoing primary ileocecal resection for CD. Four intraoperative factors were independently evaluated by 2 surgeons: length of resected ileum, mesentery thickness, presence of areas of serosal fat infiltration, or abnormal serosal vasodilation on normal bowel proximal to the resected bowel. The primary end point was early endoscopic POR at month 6 and defined as modified Rutgeerts score ≥i2b. Secondary end points were clinical and surgical recurrence., Results: Between September 2020 and November 2022, 83 consecutive patients were included. Early endoscopic recurrence occurred in 45 of 76 patients (59.2%). Clinical and biochemical recurrence occurred in 17.3% (95% confidence interval, [CI], 10.4%-28.0%) and 14.6% of the patients after 12 months. The risk of developing endoscopic and clinical recurrence was 1.127 (95% CI, 0.448;2.834, P = .799) and 0.896 (95% CI, 0.324-2.478, P = .832) when serosal fat infiltration was observed, and 1.388 (95% CI, 0.554-3.476, P = .484), and 1.153 (95% CI, 0.417;3.187, P = .783) when abnormal serosal vasodilation was observed. Similarly, length of the resected bowel and mesentery thickness showed no association with POR. A subgroup analysis on patients who received no postoperative medical prophylaxis did not identify any risk factor for endoscopic POR., Conclusions: The macroscopic appearance of the bowel and associated mesentery during surgery does not seem to be predictive of POR after ileocecal resection for CD., (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

The ligamentous structures integral to the surgical management of colon cancer include the gastrocolic ligament, the phrenicocolic ligament, and the splenocolic ligament. Historically, the era of conventional open surgery was characterized by the use of large forceps for clamping and ligating these ligaments. However, the advent of fascial and mesenteric anatomy research has ushered in a paradigm shift. Aided by high-definition laparoscopy, colorectal surgeons have progressively clarified the fundamental anatomical structures, thereby refining surgical techniques in accordance with fascial and mesenteric anatomical principles. This study synthesizes the author's anatomical research findings to dissect the fascial and mesenteric anatomy of the ligaments pertinent to colon cancer surgery, thereby exploring their implications for surgical practice and oncological outcomes. The gastrocolic ligament exhibits distinct fascial and mesenteric anatomical configurations within the omental sac and extra-omental regions. Within the omental sac, the sub-omental arch pathway emerges as a viable alternative to the paracolic approach for accessing the omental sac through the gastrocolic ligament. Conversely, in the extra-omental region, the incision of the greater omentum overlaying the space between the mesogastrium and the transverse mesocolon represents a mesenteric bridge facilitating access to this area. The incidence of nodal metastasis in the gastrocolic ligament associated with transverse colon and hepatic flexure colon cancer is notably low; nevertheless, selective dissection in high-risk patients can still provide survival benefits. The splenocolic ligament is formed by the convergence of the splenic hilum region of the mesogastrium (including the pancreatic mesentery) with the mesocolon of the splenic flexure of the colon. A natural avascular plane exists within it, and dissection along this plane can avoid encountering the branches of the left gastroepiploic artery that are typically encountered in traditional dissection routes. To date, there is no compelling evidence advocating for the resection of the splenic hilum region of the mesogastrium or the lymph nodes of the gastrocolic ligament in the context of splenic flexure colon cancer.

The concept of mesenteric anatomy has been evolving in cognition. With the continuous development of endoscopic techniques, the submicroscopic structures of many mesenteries have been gradually understood, ultimately confirming the ubiquitous presence of mesenteries in the digestive organs. Based on various domestic and foreign mesenteric anatomical theories and combined with years of clinical practice, we have summarized and proposed a new concept and theory-vascular-guided complete mesenteric resection for gastric cancer. The theoretical basis is that, from the perspective of the embryonic development of the digestive tract, the rotation of the digestive tract and its associated mesentery is always centered on blood vessels. Therefore, the supply vessels and digestive tracts and their associated mesentery are naturally connected. The mesentery is a complex structure that encompasses blood vessels, nerves, and lymphatic tissues. The blood vessels serve as the boundary of the mesentery, ensuring that the lymphatic network that drains the tumor is maximally resected. This article focuses on the complete mesenteric resection margins in gastric cancer surgery, that is, the lateral boundary of the mesentery as the vascular-supplied guided resection boundary and its mesentery, and the base boundary as the mesenteric bed. Using precise vascular guidance to define the extent of mesenteric resection will help accurately define the mesenteric margin during radical resection for different stages of gastric cancer.

Background: Intra-abdominal lymphatic malformations (LMs) are relatively rare congenital anomalies and can be divided into intra- and retroperitoneal subgroups. This study aims to evaluate the outcomes after surgical resection of intraperitoneal LMs in children., Methods: The records of all patients ≤16 years of age with intraperitoneal LMs managed at our tertiary center between 2007-2022 were reviewed. Patients with retroperitoneal LMs were excluded. Our preferred approach is surgical exploration for large (>5 cm), symptomatic lesions if they are potentially resectable on imaging., Results: A total of 12 patients (10 males) were diagnosed with intraperitoneal LMs located in the small bowel mesentery or omentum at a median age of 6.6 (range, 0.6-14.4) years. Ten (83%) patients presented with acute symptoms, including abdominal pain (n = 8; 67%) and vomiting (n = 3; 25%). Two (17%) intraperitoneal LMs were found on imaging performed for other reasons. Surgical exploration was performed in 11/12 (92%) cases. Intestinal volvulus around a mesenteric macrocyst had occurred in 4 (36%) patients. Complete macroscopic resection was achieved in 10/11 (91%) patients. Most lesions were localized to a short intestinal segment. One mixed type LM with an extensive mesenteric involvement was biopsied as the lesion was deemed to be unresectable in preoperative imaging and the diagnosis was initially unclear. There was one recurrence (8%) during postoperative follow-up on imaging (median 3.6 (range, 1.5-6.9) years) but the patient has remained asymptomatic and not undergone interventions. 6/8 (75%) of screened intraperitoneal LMs were positive for a somatic PIK3CA mutation., Conclusions: Most large, pedunculated macrocystic LMs in the small bowel mesentery or omental location were amenable to macroscopic resection. Intraperitoneal LMs tend to present with acute symptoms including a risk for intestinal volvulus based on anatomical location. Our results suggest low recurrence rates or need for further interventions over follow-up., Level of Evidence: III., Competing Interests: Conflict of interest None to declare., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Competing Interests: SDH has received consulting fees from Takeda and is a recipient of research funding from Crohn's and Colitis Foundation, and the American Society of Colon and Rectal Surgeons. BC received consulting fees from AbbVie, Prometheus, and TARGET-RWE; advisory board fees from AbbVie, Bristol Meyers Squibb, Janssen, Pfizer, and Takeda; and honoraria from ALPCO, Cornerstones Health, and Monday Night IBD.

Background: Retrospective research suggests that excision of the affected mesentery can improve outcomes after an ileocoecal resection in Crohn's disease. However, prospective data from randomised controlled trials are scarce. We aimed to compare rates of postoperative recurrence in patients with Crohn's disease who underwent extended mesenteric resection., Methods: This international, randomised controlled trial was done in six hospitals and tertiary care centres in the Netherlands and Italy. Eligible patients were aged 16 years or older and had Crohn's disease that was previously confirmed by endoscopy in the terminal ileum or ileocolic region (L1 or L3 disease), with an imaging update in the past 3 months (ultrasound, MRI, or CT enterography). Eligible patients were scheduled to undergo primary ileocolic resection with ileocolic anastomosis. Enrolled patients were assigned by use of simple random allocation (1:1) to either extended mesenteric resection (intervention) or conventional mesenteric sparing resection (control). The primary endpoint was endoscopic recurrence 6 months after surgery. Analyses were done in all patients with primary endpoint data, excluding those who had no anastomosis, a postoperative diagnosis other than Crohn's disease, or withdrew consent. This trial was registered with ClinicalTrials.gov, NCT04538638., Findings: Between Feb 19, 2020, and April 24, 2023, we assessed 217 patients for eligibility. 78 patients were excluded due to failure to meet the inclusion criteria or refusal to participate. 139 patients were enrolled and randomly assigned to either extended mesenteric resection (n=71) or mesenteric sparing resection (n=68). All 139 patients underwent surgery. Six patients were excluded after random assignment due to withdrawal of consent (n=2), postoperative diagnosis other than Crohn's disease (n=2) and no anastomosis performed (in case of a stoma; n=2). Two patients were lost to follow-up, and two more patients deviated from the protocol by undergoing investigations other than endoscopy 6 months after. 133 patients were included in the baseline analysis (67 in the extended resection group and 66 in the sparing resection group) of whom 57 (43%) were male. Baseline characteristics were similar between the groups, and median patient age was 36 years (IQR 25-54). 131 patients were analysed for the primary outcome. There was no difference between groups in the rate of endoscopic recurrence at 6 months after surgery (28 [42%] of 66 patients in the extended mesenteric resection group vs 28 [43%] of 65 patients in the mesenteric sparing resection group, relative risk 0·985, 95% CI 0·663-1·464; p=1·0). Five (8%) of 66 patients in the extended mesenteric resection group had anastomotic leakage within the 30 days after surgery, as did one (2%) of 65 in the mesenteric sparing group. Postoperative complications of Clavien-Dindo grade IIIa or higher were reported in seven (11%) patients in the mesenteric resection group and five (8%) in the mesenteric sparing group., Interpretation: Extended mesenteric resection was not superior to conventional resection with regard to endoscopic Crohn's disease recurrence. These data support the guideline-recommended mesenteric sparing approach., Funding: Topconsortia voor Kennis en Innovatie-Topsector Life Sciences & Health., Competing Interests: Declaration of interests MD received speaking fees from Bristol Meyers Squibb, Takeda, and Galapagos; served in an advisory board for AbbVie, Bristol Meyers Squibb, Celltrion, Galapagos, Janssen, and Takeda; and received grant or research support from Pfizer, Bristol Meyers Squibb, Galapagos, and Janssen. AS acted as a consultant or speaker for Johnson and Johnson, Striker, and Oasis. FF received consultant fees from AbbVie and MSD and has served for speaker for Janssen and Pfizer. GRD has served as an advisor or speaker for AbbVie, Alimentiv, Amgen, Biora, Bristol Myers Squibb, Boehringer Ingelheim, Celltrion, Ferring, Eli Lilly, enGene, Galapagos, Glaxo Smith Kline, Immunic, Index Pharmaceuticals, Johnson and Johnson, Landos, Lument, Mitsubishi Pharma, Polpharma, Prometheus Biosciences, Prometheus Laboratories, Procise Diagnostics, Protagonist, Sandoz, Setpoint, Takeda, Tillotts, and Ventyx. SD reports consultancy fees from AbbVie, Alimentiv, Allergan, Amgen, Applied Molecular Transport, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Dr Falk Pharma, Eli Lilly, Enthera, Ferring Pharmaceuticals, Gilead, Hospira, Inotrem, Janssen, Johnson & Johnson, Morphic, MSD, Mundipharma, Mylan, Pfizer, Roche, Sandoz, Sublimity Therapeutics, Takeda, Teladoc Health, TiGenix, UCB, Vial, and Vifor and reports lecture fees from AbbVie, Amgen, Ferring Pharmaceuticals, Gilead, Janssen, Mylan, Pfizer, and Takeda. CJB reports an unrestricted research grant from Boehringer Ingelheim, and Roche; received speaker's fees from Takeda, AbbVie, Janssen, MSD, and Tillots Pharma; and is part of the advisory board of Takeda. VB declares to have received support for attending a conference from THD. WAB has received research funding from VIFOR and is a consultant for Braun. The other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Introduction: The Bowel Injury Prediction Score (BIPS) is a tool for identifying patients at risk for blunt bowel and mesenteric injury (BBMI) requiring surgery. BIPS is calculated by assigning one point for each of the following: (1) WBC ≥ 17,000, (2) abdominal tenderness, and (3) injury grade ≥ 4 (mesenteric contusion or hematoma with bowel wall thickening or adjacent interloop fluid collection) on CT scan. A total score ≥ 2 is associated with BBMI requiring surgery. We aimed to validate the BIPS as a predictor for patients with BBMIs requiring operative intervention in a multi-center prospective study.Materials and Methods: Patients were prospectively enrolled at 15 U.S. trauma centers following blunt trauma with suspicion of BBMI on CT scan between July 1, 2018 and July 31, 2019. The BIPS was calculated for each patient enrolled in the study.Results: Of 313 patients, 38% had BBMI requiring operative intervention. Patients were significantly more likely to require surgery in the presence of abdominal tenderness (OR, 3.6; 95% CI, 1.6-8.0) and CT grade ≥ 4 (OR, 11.7; 95% CI, 5.7-23.7). Patients with a BIPS ≥ 2 were more than ten times more likely to require laparotomy than those with a BIPS < 2 (OR, 10.1; 95% CI, 5.0-20.4). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a BIPS ≥ 2 for BBMI requiring surgery was 72% (CI 0.6-0.8), 78% (CI 0.7-0.8), 67% (CI 0.6-0.8), and 82% (CI 0.8-0.9), respectively. The AUROC curve for BIPS ≥ 2 was 0.75. The sensitivity, specificity, PPV, and NPV of a BIPS ≥ 2 for BBMI requiring surgery in patients with severe alteration in mental status (GCS 3-8) was 70% (CI 0.5-0.9), 92% (CI 0.8-1.0), 82% (CI 0.6-1.0), and 86% (CI 0.7-1.0), respectively.Conclusion: This prospective multi-center trial validates BIPS as a predictor of BBMI requiring surgery. Calculation of BIPS during the initial evaluation of trauma patients is a useful adjunct to help general surgeons taking trauma call determine operative versus non-operative management of patients with BBMI including those with severe alteration in mental status. [ABSTRACT FROM AUTHOR]

Background: Mesenteric cysts are rare intra-abdominal masses and high index of suspicion is required to clinically suspect this pathology and make a definitive diagnosis. They are most commonly located in the ileal mesentery but can be located anywhere along the gastrointestinal tract mesentery and may extend into the retroperitoneum. The rarity of these anomalies and diversity of clinical picture pose challenges in the diagnosis and operative management. The objective of this study is to determine the demographic pattern, clinicopathological diagnosis and management outcome of mesenteric cysts in our hospital.Materials and Methods: This retrospective study was conducted on children operated for mesenteric cysts from October 2013 to September 2020. Statistical analysis was performed using Open Epi Version 3.01.Results: Out of 32 children with a diagnosis of mesenteric cyst, 78% were below 5 years of age. Small intestine was affected in 26 cases and large bowel mesentery was the site of origin in six cases. Complete excision of mesenteric cyst was possible in all cases. Bowel resection was required in ten cases (31%) to enable complete excision. Bowel resection was required more often in children operated on emergency than those with elective surgery, and is statistically significant (P = 0.04; confidence interval: 0.05-0.96, odds ratio: 0.23). An uncommon co-existence with ileal atresia and detection of rare chylolymphatic cyst in another infant were also remarkable findings. Histopathology proved the diagnosis in all cases. There was no mortality or recurrence during hospitalisation and follow-up, which ranged from 3 months to 3 years.Conclusions: Mesenteric cysts present with diverse clinical features and children below 5 years of age are most commonly affected. Complete surgical excision is the optimal treatment and may require bowel resection in significant number of cases, especially those operated during emergency. Histopathology is the gold standard for diagnosis. [ABSTRACT FROM AUTHOR]

Carl Florian Toldt was an Austrian anatomist who made meaningful contributions worldwide and defined what is one of the most important surgical landmarks in abdominal surgery. Through his research studies, the embryologic dissection plane known as the "White Line of Toldt" represents an important anatomical landmark that helps to mobilize either the ascending or descending colon. His career spanned over 45 years, beginning in Verona and continuing to Prague and Vienna. He was an author of several innovative books and scientific articles regarding micro- and macroscopic anatomy. In addition, he received numerous recognitions and prizes for his work, making him an essential figure in the medical scientific community. Even a street in Vienna, Karl-Toldt-Weg, is named in his honor. The purpose of this historical article is to celebrate and honor Toldt 100 years following his death, remembering his scientific contributions to the medical and surgical fields and giving thanks for his numerous accomplishments. This article brings light to the man behind the eponym. [ABSTRACT FROM AUTHOR]

Background: Colectomies performed according to complete mesocolic excision with central vascular ligation (CME-CVL) principles have been associated with enhanced oncologic outcomes. Nonetheless, laparoscopic CME-CVL right hemicolectomy has not been widely adopted. We aimed to compare the perioperative and pathology outcomes of laparoscopic and open CME-CVL right hemicolectomy. Materials and Methods: We compared data from a prospectively collected database regarding patients who underwent either laparoscopic or open CME-CVL right hemicolectomy for nonmetastatic right colon cancer in a University Hospital, between January 2012 and December 2018. Results: A total of 130 consecutive patients were included in the study. Of them, 73 patients underwent laparoscopic and 57 patients open right colectomy, following the CME-CVL principles. The laparoscopic approach was associated with less hospital stay (6.6 versus 9.1 days; P < .001) and septic complications (P = .046), at a cost of an increased operative time (180 versus 125.1 minutes; P < .001). Patients treated with either open or laparoscopic approach presented similar outcomes regarding pathology endpoints. In fact, both groups demonstrated similar R0 resection rate (P = .202), number of harvested and positive lymph nodes (P = .751 and P = .734, respectively), number of harvested lymph nodes at the level of D1 and D2 lymph node dissection (P > .05), rate of vascular (P = .501), and perineural infiltration (P = .956). Furthermore, no difference was found regarding the rate of intact mesocolic plane (P = .799), along with the tumor diameter (P = .154) and the length of specimen (P = .163). Conclusion: Laparoscopic CME-CVL right hemicolectomy appears to offer certain advantages in short-term outcomes compared to open procedure. Pathology outcomes did not differ between the two approaches. Future studies should further evaluate their long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Standardized protocols for laparoscopic surgery of splenic flexure cancer (SFC) have not been established yet. We described a standardized laparoscopic procedure for SFCs and examined its safety and feasibility. Methods: Laparoscopic colectomy for SFC was performed as follows. The sigmoid colon was mobilized to the descending mesocolon through the medial approach. After confirming the base of the inferior mesenteric artery, the left colic artery was dissected and resected at the base. Further dissection was carried out between the mesentery of the colon and the renal fascia until it exceeded the upper pole of the left kidney and the splenic flexure. The next dissection reached the white line at the lateral side and the sigmoid-descending colon junction. After making an incision at the greater omentum and gastrocolic ligament from the center of the transverse colon to the splenic flexure, the transverse mesocolon base was dissected from the inside splenic flexure for complete mobilization. This was performed by approaching from four directions toward the splenic flexure. Intestinal resection and anastomosis are performed. Results: This procedure was performed in 70 patients with splenic flexure colon cancer (mean age 70 years). The mean operative time was 190 minutes, and the mean blood loss was 2.0 mL. No notable perioperative or postoperative complications were noted. Conclusions: Safe mobilization of the splenic flexure can be achieved by approaching from four directions, and standardization of left colectomy can facilitate complete mesenteric excision. [ABSTRACT FROM AUTHOR]

Cystic lymphangioma are rare benign vascular or lymphatic tumors, diagnosed mostly in newborns or children, that may become life‐threatening because of local invasiveness. Surgical "en‐bloc" resection with negative margins is the only curative treatment, but some patients are diagnosed with unresectable tumors. We describe the case of a young adult with giant unresectable mesenteric lymphangioma. Extensive pathological characterization as well as whole exome and transcriptome sequencing enabled us to identify mTOR pathway activation within endothelial tumor cells. The patient was treated with everolimus and experienced major partial response, leading to the surgical resection of the residual lesions. This case highlights the importance of molecular characterization of adult cystic lymphangioma for mTOR pathway activation because multidisciplinary therapeutic approaches, including neoadjuvant everolimus and secondary surgery, can lead to complete cure of this rare condition. Key Points: The case of an adult patient diagnosed with giant unresectable mesenteric cystic lymphangioma, in which activation of the mTOR pathway was documented at both the pathological and transcriptomic levels, is reported.This patient showed major partial response to the mTOR inhibitor everolimus, which led to the successful resection of residual tumor lesions after 9 months of treatment.This report shows that mTOR targeting should be considered as neoadjuvant treatment in adult large cystic lymphangioma, as it can lead to complete surgery and cure of this rare condition. This article reports the case of an adult patient diagnosed with giant unresectable mesenteric cystic lymphangioma, highlighting the importance of molecular characterization of these rare tumors for mTOR pathway activation and the multidisciplinary therapeutic options that can lead to cure of this rare condition. [ABSTRACT FROM AUTHOR]

Background: Persistent descending mesocolon (PDM) is typically asymptomatic. However, features such as adhesion and variations in vessel anatomy could affect the surgical techniques for colorectal cancer (CRC). This study aimed to investigate the frequency and radiological features of PDM. Short-term outcomes after conventional laparoscopic surgery (CLS) for CRC with PDM were also investigated to assess the feasibility of CLS and identify strategies for minimally invasive surgery (MIS) in CRC with PDM.Methods: Patients who underwent MIS, including CLS and robot-assisted laparoscopic surgery (RALS), for left-sided CRC between April 2016 and June 2019, were investigated. PDM was defined as the existence of the right border of the descending colon inside the right border of the left kidney based on preoperative computed tomography findings.Results: Radiological findings of 837 patients were examined, and PDM was found in 19 (2.3%) patients. Radiality of the inferior mesenteric artery (IMA) was found in 5 of 19 (26.3%) PDM cases, which was significantly higher than that in non-PDM cases. The median lengths between the IMA and inferior mesenteric vein (IMV) and between the IMV and descending colon in PDM cases were 14.8 mm and 17.2 mm, respectively, which were significantly shorter than those in non-PDM cases. Short-term outcomes were evaluated only in CLS cases since the rate of hybrid surgery among RALS cases differed between non-PDM and PDM cases (0% vs. 44.4%), which would affect the surgical outcomes. The short-term outcomes in 447 CLS cases were similar between PDM and non-PDM cases. The frequency of extracorporeal division of the left colic artery (LCA) and IMV was significantly higher in PDM than in non-PDM cases (70.0% vs. 5.7%).Conclusions: This radiological definition of PDM was feasible. CLS for left-sided CRC with PDM was feasible, and dividing the LCA and IMV extracorporeally would be vital for safe surgery. [ABSTRACT FROM AUTHOR]

Mesenteric cysts of the abdomen affecting patients of end‑stage renal disease (ESRD) are not common. In the absence of symptoms, they may remain undetected unless large in size. When present, the cysts have to be treated by surgical excision. In patients awaiting kidney transplantation, surgery for the cyst can be a potential hindrance in the planning of transplantation as morbidity and mortality of surgery in patients of ESRD is very high. We report a 27‑year‑old male awaiting kidney transplantation, who presented to us with a large mesenteric cyst. We conducted a simultaneous surgery of mesenteric cyst and kidney transplantation successfully. [ABSTRACT FROM AUTHOR]

Rationale: Diffuse intestinal and mesenteric lipomatosis is a rare condition characterized by the overgrowth of adipose tissue in the intestines and mesentery. This case report aims to highlight the rare occurrence of chronic abdominal distention caused by this disease and its unique invasion into the muscle layer, which has not been previously reported., Patient Concerns: A 36-year-old woman with a 7-year history of abdominal distension was admitted to our hospital's Department of Gastrointestinal Surgery., Diagnose: Abdominal and pelvic computed tomography revealed diffuse small intestinal lipomatosis., Interventions: The patient underwent surgery. We performed an open-field ilectomy involving removal of all lipomatous intestines (250 cm)., Outcomes: During the surgery, diffuse nodular ileal and mesenteric lipomatosis was confirmed, characterized by the presence of multiple nodular lipomas within the submucosal and muscular layers. The surgical intervention involved the resection of 250 cm of the affected ileum, followed by jejunoileal anastomosis. Postoperative pathology confirmed the diagnosis, with lesions observed in both the submucosa and muscle layers. The patient showed significant improvement in symptoms, with normal intestinal function and weight gain observed over a 10-month follow-up period, and no signs of recurrence., Lessons: Diffuse intestinal and mesenteric lipomatosis can lead to long-term abdominal distension. Additionally, it may be involved in the muscle layer of the intestinal wall. Surgery is the primary treatment option for symptomatic intestinal lipomatosis., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Internal herniation (IH) is a common problem after laparoscopic Roux-en-Y gastric bypass surgery (RYGB). Routine closure of the mesenteric defects (MDs) reduces the risk of IH. Only very few articles report on risk factors for IH or describe detailed closing techniques. There is no consensus yet on the best closing method. The objective of this study is to determine the optimal stapling method for closure of MDs after RYGB. All performed RYGB procedures in our high-volume bariatric institute were included. Quality of the closure was scored in the categories poor, sub-optimal, and optimal, to see if the quality of the closure would predict the chance of reopening of the MDs and, therefore, the chance of IH. During any type of laparoscopy in the follow-up of the patient, the conditions of the MDs were stated, for example during diagnostic laparoscopy in symptomatic patients suspicious for IH or during laparoscopic cholecystectomy. Technically well-executed closure of Petersen's space (PS) with two rows of staples had a greater chance of still being closed upon re-inspection compared to closure with one row (odds ratio = 8.1; 95% confidence interval [1.2-53.2], p = 0.029). Optimal closure of the MD at the jejuno-jejunostomy (JJ-space, JJS) resulted in more closed JJSs upon re-inspection compared to sub-optimal closure (odds ratio = 3.6 [CI 95% 0.8-16.1], p = 0.099). Non-optimally closed MDs had higher reopening rates and, therefore, pose an additional risk for IH. Our classification provides a quality assessment of MD closure during RYGB and gives insight into how to optimize surgical technique., (© 2024. The Author(s).)

Introduction: Internal hernia (IH) after Roux-Y gastric bypass (RYGB) can lead to extended small bowel ischemia if it not recognized and treated promptly. The aim of this study is to show whether improvement in mesenteric defect (MD) closure reduces the incidence of IH., Patients and Methods: Retrospective analysis of prospectively collected data from our database including all patients who underwent laparoscopic RYGB between 1999 and 2015. The usual technique was a retrocolic/retrogastric RYGB. We divided patients in four groups according to the closure technique for MD and compared incidences of IH between groups. All patients had at least 8 years of follow-up., Results: A total of 1927 patients (1497 females/460 males, mean age of 41.5 ± 11 years) were operated. A retrocolic/retrogastric RYGB was performed in 1747 (90.7%) and an antecolic RYGB in 180 patients. Mean duration of follow-up was 15 (8-24) years. 111 patients (5.8%) developed IH, the majority through the jejunojejunostomy (JJ, 3.7%) and Petersen (1.7%) defects. With improvement of closure technique, the incidence decreased over time, from 12.9% in the group with separate sutures to 1.05% in the most recent group with running non-absorbable sutures and an additional purse-string at the JJ defect (p < 0.0001)., Conclusion: Meticulous closure of MD during RYGB is a very important step that significantly reduces the IH risk after RYGB, even with a retrocolic/retrogastric anatomy. Using running non absorbable braided sutures and an additional purse-string suture at the JJ is the most effective technique, but a small IH risk persists. A high index of suspicion remains necessary in patients who present with acute abdominal pain after RYGB., (© 2024. The Author(s).)

Postoperative anastomotic recurrence of Crohn's disease is challenging and can lead to symptom recurrence and further surgery. The mesenteric pole of the intestine is the initial site of macroscopic anastomotic recurrence, and the mesentery may play an important role in recurrence after surgical resection. Therefore, "mesenteric-based surgery" has gained increasing attention by clinicians. However, the role of mesentery in the postoperative recurrence remains controversial. This review will examine mesenteric changes in Crohn's disease, proposed roles for mesentery in disease progression, and the potential for mesenteric-based surgery in the surgical management of Crohn disease., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is associated with significant morbidity and mortality. We present an alternative technique that preserves the complete mesenteric vascularization during the isolation of the intestinal segment used in ICUD, including distal vessels. This approach aims to minimize the risk of ischemia in both the ileal anastomosis and the isolated loop at the diversion site., Methods: This cohort study included 31 patients, both male and female, who underwent RARC with ICUD from February 2018 to November 2023, performed by a single surgeon. Intraoperative and postoperative complications data were retrieved for analysis, employing our proposed mesentery-sparing technique in all cases. The primary endpoint was the incidence of intraoperative and postoperative complications directly attributable to the mesentery-sparing approach in ICUD. Secondary endpoints included other postoperative variables not directly related to mesentery preservation, such as the incidence of postoperative ileus requiring parenteral nutrition and the duration of hospitalization., Results: None of the patients experienced intraoperative or postoperative complications directly related to mesentery-sparing, such as intestinal fistulae or internal hernias. The median duration of hospitalization was 6 days, and postoperative ileus necessitating total parenteral nutrition occurred in 19% of the patients. Minor complications (Clavien-Dindo grades I-II) accounted for 27.6% of the cases and major complications (grades III-V) accounted for 20.6%., Conclusion: The mesentery-sparing technique outlined herein offers an alternative method for preserving the vascularization of intestinal segments and reducing the risk of intestinal complications in ICUD during RARC., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Abstract: Transmesentric hernias are a type of internal hernia, in which there is herniation of bowel loops through a defect in the mesentery. They present with a wide variety of symptoms without any specific radiological features, leading to a delay in diagnosis and high mortality rate. Here, we present a case series of four patients with this rare but fatal cause of small bowel obstruction. Three children presented to the emergency department with small bowel obstruction. The other baby was a preterm neonate with an antenatal scan showing small bowel obstruction. All children underwent emergency laparotomy and were found to have a mesenteric defect with herniation and gangrene of the small bowel. Resection anastomosis of the gangrenous segment and closure of the mesenteric defect were done. The differential for small bowel obstruction in children should include transmesentric hernia. Laboratory or imaging investigations are often inconclusive. Timely exploration can save lives in this rare but life-threatening condition., (Copyright © 2023 Copyright: © 2023 African Journal of Paediatric Surgery.)

Common mesentery is an abnormal rotation of the primary umbilical loop characterized by inverted positioning of the mesenteric vessels; the mesenteric vein is displaced to the left of the artery. The inversion can be complete or incomplete. If it is incomplete, the mesenteric root is very short, with an empty right iliac fossa and the caecum in high median or subhepatic position. If it is complete, the entire small intestine is on the right, the entire large intestine is on the left; there is no third duodenum, and the second duodenum is anastomosed in the jejunum to the right of the superior mesenteric vessels. Cecal volvulus is a rarely encountered cause of acute intestinal occlusion and should be considered as a surgical emergency. There exist two main types of volvulus: by twisting of the large intestine around its axis, which remains in place; or by tilt and to rotation of the colon, which changes position., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate the clinical value of CT angiography (CTA), CT colonography (CTC), and image fusion in the preoperative evaluation of laparoscopic complete mesocolic excision (CME) for right colon cancer.Methods: In this randomized prospective study, 80 patients undergoing laparoscopic CME for right colon cancer were randomly divided into two groups: image fusion [the original images were reconstructed using CTA and CTC, then fused into three-dimensional images of the blood vessels and intestines (n = 40)] and control (without CTA and CTC reconstruction before surgery). All patients underwent plain and enhanced abdominal CT before surgery.Results: In the image fusion group, the gastrocolic trunk of Henle was present in 33 cases, and its branches originated from the colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. Among these patients, 5 exhibited the right gastroepiploic vein and superior anterior pancreaticoduodenal vein; 21 exhibited a gastrointestinal trunk consisting of 2 or 3 branches of the right gastroepiploic vein, right colon vein, and middle colon vein; and 7 exhibited 3 or 4 gastro-pancreatic and colon trunks consisting of the right colon vein, middle colon vein, right gastroepiploic vein, and superior anterior pancreaticoduodenal vein. The correspondence with the anatomy actually observed during surgery was 100%. Compared with the conventional CT group, the duration of the operation in the image fusion group was shorter, with reduced intraoperative bleeding, and more lymph node dissection. There were no significant differences in the incidence of complications and length of hospital stay between the two groups (p > 0.05).Conclusions: For laparoscopic CME for right colon cancer, CTA, CTC, and image fusion were effective preoperative evaluation methods, which avoided some unseen dangers in the operation process and led to better therapeutic outcomes. [ABSTRACT FROM AUTHOR]