The Experts below are selected from a list of 165 Experts worldwide ranked by ideXlab platform
Dennis S. Chi - One of the best experts on this subject based on the ideXlab platform.
-
Diaphragm Hernia after debulking surgery in patients with ovarian cancer
Gynecologic oncology reports, 2021Co-Authors: Sarah Ehmann, Emeline M. Aviki, Yukio Sonoda, Thomas Boerner, Dib Sassine, David R. Jones, Bernard J. Park, Murray Cohen, Norman G. Rosenblum, Dennis S. ChiAbstract:Over 80% of patients with epithelial ovarian cancer present with advanced disease, FIGO stage III or IV at the time of diagnosis. The majority require extensive upper abdominal surgery to obtain complete gross resection. This may include splenectomy, distal pancreatectomy, partial hepatectomy, cholecystectomy, and usually Diaphragmatic peritonectomy or resection. Following surgery, Diaphragmatic Hernia-a very rare but serious complication-may occur. We describe four cases of left-sided Diaphragmatic Hernia resulting after debulking surgery, which included left Diaphragm peritonectomy and splenectomy, in patients with advanced ovarian cancer. In association with the current shift towards more extensive debulking surgery for ovarian cancer, more patients may present with postoperative left-sided Diaphragm Hernia, making the prevention, diagnosis, and management of this complication important to practicing gynecologic oncologists. Intraoperatively the Diaphragm should be checked thoroughly to rule out any defects, which should be closed. A Diaphragmatic Hernia may be easily misdiagnosed because the patient can present with various symptoms. While rare, these Hernias require prompt identification, intervention and surgical correction to avoid serious complications.
-
Minimally invasive repair of a left Diaphragm Hernia after debulking surgery for advanced ovarian cancer.
Gynecologic oncology reports, 2021Co-Authors: Sarah Ehmann, Bernard J. Park, Dennis S. ChiAbstract:Abstract Eighty percent of women with ovarian cancer have advanced disease (FIGO stage III or IV) at the time of diagnoses and require extensive upper abdominal surgery to obtain complete gross resection ( Minig, 2015 , Eisenhauer, 2006 ). A Diaphragmatic Hernia is defined as abdominal contents bulging into the thoracic cavity ( Spellar and Gupta, 2020 ). While rare following primary debulking surgery (PDS), these present with a variety of symptoms and are often misdiagnosed. Computed tomography (CT) is the diagnostic gold standard. ( Vertaldi, 2020 ) This video demonstrates repair of a left-sided complex Diaphragm Hernia via robotic video-assisted thoracic surgery in a 45-year-old with stage IVB ovarian cancer. She previously underwent extensive PDS, including modified posterior exenteration, bilateral salpingo-oophorectomy, omentectomy, bilateral pelvic lymph node dissection, appendectomy, bilateral Diaphragm peritonectomy, splenectomy, resection of a right mediastinal lymph node, and insertion of a right chest tube. Complete gross resection was achieved. No left-sided Diaphragm resection or repair was performed during the initial surgery. She received standard adjuvant chemotherapy with paclitaxel, carboplatin and bevacizumab. Six months postoperatively a surveillance CT scan revealed a small left hemiDiaphragm Hernia containing parts of the stomach. Although initially asymptomatic, she developed mild symptoms on follow-up, especially with lying supine. Imaging showed an increase in the size of the Diaphragm defect. After completion of her maintenance bevacizumab therapy, corrective surgery was performed to prevent incarceration of the stomach. This video demonstrates the complex repair of this 4 x 6 cm defect located in the central tendon of the Diaphragm. On two-week follow-up after corrective surgery, the patient’s symptoms had resolved.
-
minimally invasive repair of a left Diaphragm Hernia after debulking surgery for advanced ovarian cancer
Gynecologic oncology reports, 2021Co-Authors: Sarah Ehmann, Bernard J. Park, Dennis S. ChiAbstract:Abstract Eighty percent of women with ovarian cancer have advanced disease (FIGO stage III or IV) at the time of diagnoses and require extensive upper abdominal surgery to obtain complete gross resection ( Minig et al., 2015 , Eisenhauer et al., 2006 ). A Diaphragmatic Hernia is defined as abdominal contents bulging into the thoracic cavity ( Spellar and Gupta, 2020 ). While rare following primary debulking surgery (PDS), these present with a variety of symptoms and are often misdiagnosed. Computed tomography (CT) is the diagnostic gold standard ( Vertaldi et al., 2020 ). This video demonstrates repair of a left-sided complex Diaphragm Hernia via robotic video-assisted thoracic surgery in a 45-year-old with stage IVB ovarian cancer. She previously underwent extensive PDS, including modified posterior exenteration, bilateral salpingo-oophorectomy, omentectomy, bilateral pelvic lymph node dissection, appendectomy, bilateral Diaphragm peritonectomy, splenectomy, resection of a right mediastinal lymph node, and insertion of a right chest tube. Complete gross resection was achieved. No left-sided Diaphragm resection or repair was performed during the initial surgery. She received standard adjuvant chemotherapy with paclitaxel, carboplatin and bevacizumab. Six months postoperatively a surveillance CT scan revealed a small left hemiDiaphragm Hernia containing parts of the stomach. Although initially asymptomatic, she developed mild symptoms on follow-up, especially with lying supine. Imaging showed an increase in the size of the Diaphragm defect. After completion of her maintenance bevacizumab therapy, corrective surgery was performed to prevent incarceration of the stomach. This video demonstrates the complex repair of this 4 × 6 cm defect located in the central tendon of the Diaphragm. On two-week follow-up after corrective surgery, the patient’s symptoms had resolved.
S.-c. Kang - One of the best experts on this subject based on the ideXlab platform.
-
The feasibility and efficacy of laparoscopic repair for chronic traumatic Diaphragmatic Herniation: introduction of a novel technique with literature review
Hernia, 2016Co-Authors: C.-h. Liao, C.-h. Chu, F.-j. Hsieh, S.-y. Wang, Y.-p. Hsu, S.-c. KangAbstract:Purpose Traumatic Diaphragm rupture is a rare trauma that is easily overlooked. A missed diagnosis would result in chronic traumatic Diaphragmatic Herniation (CTDH). Surgical repair is the standard treatment that is conventionally performed by laparotomy or thoracotomy. Laparoscopic repair has been reported, but its efficacy remains controversial. In this study, we present our novel technique and experience of laparoscopic repair of CTDH and analyze the feasibility and effectiveness of this procedure. Methods We conducted a prospective collection with retrospective review of patients with CTDH treated at Chang Gung Memorial Hospital, Taiwan, from 2000 to 2013. The demographic characteristics, surgical procedure, perioperative results, length of hospital stay (HLOS) and follow-up were record and analyzed. Results There were 114 patients with traumatic Diaphragm Hernia, and 24 of them had CTDH with a mean age of 54.9 ± 13.3 years. The HLOS was 15.08 ± 8.17 days. Regarding the surgical method used, 19 patients had open surgery, and 5 patients underwent laparoscopic surgery. The demographic distribution, trauma mechanism, location and size of CTDH were comparable. In the laparoscopic group, the patients had a shorter median HLOS (6 days) than in the open surgery group (16 days; p = 0.002). There was no mortality or recurrence in both groups. Conclusions In this study and literature review, patients had laparoscopic repair with a smooth recovery. Laparoscopy provides good surgical exposure, allowing easy repositioning of the Herniated content and a smooth repair of the defect without the morbidity of laparotomy. For CTDH, with caution, we can apply this technique with an acceptable result.
Rafael S. Andrade - One of the best experts on this subject based on the ideXlab platform.
-
Long Term Results of Diaphragm Hernia Repair After Left Ventricular Assist Device Explantation
The Annals of thoracic surgery, 2020Co-Authors: Ilitch Diaz-gutierrez, Alexandria J. Robbins, Benjamin Zhang, Madhuri Rao, Amit Bhargava, Rafael S. AndradeAbstract:Abstract Background Diaphragm Hernias post explantation of a left ventricular assist device (LVAD) at the time of heart transplant are uncommon, but can be morbid. We present our mid to long-term results of Diaphragm Hernia repair in these patients. Methods A retrospective chart review was performed on our prospectively collected database of all patients who had sequential LVAD explantation and heart transplant at our institution since 1995. All patients who developed a Diaphragm Hernia were included in the study. Patient demographics, perioperative morbidity and long-term results were recorded. Results From January 1995 to June 2018 we placed 712 LVADs, and subsequently transplanted 293 hearts. The incidence of Diaphragm Hernia following heart transplant was 7.1% (n = 21) with a median time from transplant to diagnosis of 23 months (Interquartile range [IQR] 9-39). Four patients did not undergo operative repair and one was excluded for insufficient data. Sixteen patients underwent Diaphragm Hernia repair (male=13, female=3). Thirteen patients underwent laparoscopic repair with mesh, and three had open repair. Two patients presented with strangulated Hernias requiring laparotomy and bowel resection. Median follow up time was 53 months (IQR 12-141) for the entire cohort. We had one recurrence (6.2%) in a patient with laparoscopic repair. Conclusions Diaphragm Hernia repair after sequential left ventricular assist device explantation and orthotopic heart transplant is feasible and appears to be safe. When diagnosed, patients should be referred for surgical evaluation.
A Längler - One of the best experts on this subject based on the ideXlab platform.
-
Clinical courses of trisomy 18 (Edwards syndrome) - an update
Zeitschrift fur Geburtshilfe und Neonatologie, 2011Co-Authors: M Thiel, P Blanke, A LänglerAbstract:In current literature the prognosis of trisomy 18 is mainly described as inevitably lethal. After intervention of parental organisations infants have been treated with cardio surgery in the USA, later in Europe as well with good results. We report the consequences of this and similar developments on our pre- und postnatal approach after diagnosis in our department. PATIENTS AND CASE REPORTS: 2 parents decided to carry the child to term after the recommendation for abortion. According to standard perinatological aspects one child was vaginally delivered, the second with Caesarean section. After informed consent with the parents we planned a supportive management without more resuscitation than stimulation and ventilation by mask. Both children could be stabilised with nasal CPAP. The first one had been operated on a double outlet right ventricle at the age of 6 months, the second needed to be operated for Diaphragm Hernia. The third child had been delivered by emergency Caesarean section. A bilateral choanal atresia had been operated in the first week of life, a double outlet right ventricle at the age of 15 days. One child is fed by a nasogastric tube, one is bottle-fed and one had a percutanous gastric tube until he died due to septicaemia, all have statomotorically retardation and had periods of pulmonary hypertension. The social situation of the families is characterised by a stable parental relationship and a safe socio-economical status. None of the children had an acute lethal malformation. In single cases a prospective management in patients with trisomy 18 can be possible. Besides medical issues, the emotional parental wish, their social network and economical status are crucial. The prognosis of trisomy 18 is poor. 3 patients and 20 months do not allow any general statements. However, our recent experience and the courses in the recent literature show that in single cases a more prospective management is possible. © Georg Thieme Verlag KG Stuttgart · New York.
-
Klinische Verläufe bei Trisomie 18 (Edwards-Syndrom) – Ein Update
Zeitschrift Fur Geburtshilfe Und Neonatologie, 2011Co-Authors: M Thiel, P Blanke, A LänglerAbstract:Background In current literature the prognosis of trisomy 18 is mainly described as inevitably lethal. After intervention of parental organisations infants have been treated with cardio surgery in the USA, later in Europe as well with good results. We report the consequences of this and similar developments on our pre- und postnatal approach after diagnosis in our department. PATIENTS AND CASE REPORTS: 2 parents decided to carry the child to term after the recommendation for abortion. According to standard perinatological aspects one child was vaginally delivered, the second with Caesarean section. After informed consent with the parents we planned a supportive management without more resuscitation than stimulation and ventilation by mask. Both children could be stabilised with nasal CPAP. The first one had been operated on a double outlet right ventricle at the age of 6 months, the second needed to be operated for Diaphragm Hernia. The third child had been delivered by emergency Caesarean section. A bilateral choanal atresia had been operated in the first week of life, a double outlet right ventricle at the age of 15 days. One child is fed by a nasogastric tube, one is bottle-fed and one had a percutanous gastric tube until he died due to septicaemia, all have statomotorically retardation and had periods of pulmonary hypertension. The social situation of the families is characterised by a stable parental relationship and a safe socio-economical status. None of the children had an acute lethal malformation. Discussion In single cases a prospective management in patients with trisomy 18 can be possible. Besides medical issues, the emotional parental wish, their social network and economical status are crucial. Conclusion The prognosis of trisomy 18 is poor. 3 patients and 20 months do not allow any general statements. However, our recent experience and the courses in the recent literature show that in single cases a more prospective management is possible.
C.-h. Liao - One of the best experts on this subject based on the ideXlab platform.
-
The feasibility and efficacy of laparoscopic repair for chronic traumatic Diaphragmatic Herniation: introduction of a novel technique with literature review
Hernia, 2016Co-Authors: C.-h. Liao, C.-h. Chu, F.-j. Hsieh, S.-y. Wang, Y.-p. Hsu, S.-c. KangAbstract:Purpose Traumatic Diaphragm rupture is a rare trauma that is easily overlooked. A missed diagnosis would result in chronic traumatic Diaphragmatic Herniation (CTDH). Surgical repair is the standard treatment that is conventionally performed by laparotomy or thoracotomy. Laparoscopic repair has been reported, but its efficacy remains controversial. In this study, we present our novel technique and experience of laparoscopic repair of CTDH and analyze the feasibility and effectiveness of this procedure. Methods We conducted a prospective collection with retrospective review of patients with CTDH treated at Chang Gung Memorial Hospital, Taiwan, from 2000 to 2013. The demographic characteristics, surgical procedure, perioperative results, length of hospital stay (HLOS) and follow-up were record and analyzed. Results There were 114 patients with traumatic Diaphragm Hernia, and 24 of them had CTDH with a mean age of 54.9 ± 13.3 years. The HLOS was 15.08 ± 8.17 days. Regarding the surgical method used, 19 patients had open surgery, and 5 patients underwent laparoscopic surgery. The demographic distribution, trauma mechanism, location and size of CTDH were comparable. In the laparoscopic group, the patients had a shorter median HLOS (6 days) than in the open surgery group (16 days; p = 0.002). There was no mortality or recurrence in both groups. Conclusions In this study and literature review, patients had laparoscopic repair with a smooth recovery. Laparoscopy provides good surgical exposure, allowing easy repositioning of the Herniated content and a smooth repair of the defect without the morbidity of laparotomy. For CTDH, with caution, we can apply this technique with an acceptable result.