Aortic Hemiarch and Valve Replacement for Severe Aortic Stenosis with Ascending Aortic Ectasia
Adeel Ahmad, MD; Peter A. Collings, MD; Kirill Zakharov, DO
University of Michigan Health-Sparrow
Severe aortic valvular stenosis is a prevalent condition with potentially fatal consequences. Presenting symptoms may include dyspnea with angina/chest pains that can be significantly lifestyle limiting. Early detection and treatment are paramount to effective management, as untreated severe aortic stenosis has a five-year mortality of 50–70%. Treatment options range from the minimally invasive transcatheter approach to open heart surgery. Each strategy is tailored to the respective patient’s presentation, with considerations for cardiac anatomy, comorbidities, and patient frailty. When concomitant aortopathy is present, an open approach allows for definitive management of both conditions.
Aortic ectasia is an abnormal dilation of the ascending aorta that, while itself is not as serious, can be a precursor to aortic aneurysm or dissection. In patients undergoing surgical aortic valve replacement, a composite replacement strategy can also address concomitant aortic ectasia by incorporating the new valve into an aortic graft segment as a single implant.
Laparoscopic Percutaneous Extraperitoneal Closure (LPEC) for an Inguinal Hernia in a Pediatric Female
Yuki Noguchi, MD, PhD; Shogo Saito, MD; Shohei Hiwatashi, MD, PhD; Satoshi Umeda, MD, PhD; Masahiro Zenitani, MD, PhD; Keigo Nara, MD, PhD
Osaka Women’s and Children’s Hospital
Pediatric inguinal hernias are indirect, resulting from a persistent patent processus vaginalis (PPV). These hernias will not spontaneously heal and carry a serious, persistent risk of incarceration. Consequently, surgical repair is typically advised soon after diagnosis to minimize the risk of incarceration.
This report details a 4-year-old girl with a reducible left inguinal hernia containing the greater omentum undergoing minimally invasive laparoscopic percutaneous extraperitoneal closure (LPEC). LPEC offers improved visualization, superior cosmetic results, and the ability to identify and repair contralateral PPV during the same procedure, which reduces the risk of metachronous hernia—particularly in girls, where the technique is technically straightforward.
Pediatric Laparoscopic Splenectomy for Splenomegaly due to Hereditary Spherocytosis
Swetha Jayavelu, MD; Marc Mankarious, MD; Bryanna M. Emr, MD
Penn State Health Milton S. Hershey Medical Center
Hereditary spherocytosis (HS) is a form of inherited hemolytic anemia seen in children. HS is characterized by anemia, jaundice, splenomegaly, and complications such as gallstone formation or growth delay. While mild cases may be managed conservatively, splenectomy remains the definitive treatment for patients with severe symptoms or complications. This case presents a 10-year-old male with HS who presented with anemia, fatigue, abdominal pain, and palpable splenomegaly. He was found to have splenomegaly with a splenic length of 19.6 cm. He ultimately underwent a laparoscopic total splenectomy after receiving appropriate preoperative vaccinations. The procedure was completed successfully without complications, and the patient was discharged on post-op day 3. At follow-up, he demonstrated improved hemoglobin levels, resolution of abdominal pain, and no early complications. This case highlights the role of laparoscopic total splenectomy as a safe and effective treatment for pediatric patients with hereditary spherocytosis and massive splenomegaly, offering durable hematologic improvement with the benefits of a minimally invasive approach.
Setup for an Open Total Thyroidectomy (South College, Knoxville, TN)
Melissa Yearwood, AS-ST, CST
South College, Knoxville, TN
For every surgical procedure, a sterile, well-organized back table setup is needed to provide surgical efficiency and patient safety. This educational video demonstrates a setup for an open total thyroidectomy. This surgical procedure is performed to treat various conditions. The setup protocol provided here shows how to create the sterile field and position instruments and supplies to allow for quick access while maintaining sterility throughout the procedure.
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