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All Journal Diponegoro International Medical Journal (DIMJ)
Fuadi, Ahmad Fathi
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Medicine & Pharmacology Neuroscience

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Intraoperative Endoscopy as Guidance for Adequate Myotomy in Laparoscopic Heller Procedure: A Rare Case Report Fuadi, Ahmad Fathi; Mahfuddin, Ahmad Za'im Muhtar
Diponegoro International Medical Journal Vol 4, No 2 (2023): December 2023
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v4i2.17840

Abstract

Background: Esophageal achalasia is a rare disorder characterized by the absence of lower esophageal sphincter (LES) relaxation. The cardinal symptom is progressive dysphagia. Laparoscopic Heller myotomy (LHM) for achalasia offers long-term symptom improvement. However, there is no precise length or landmark for adequate myotomy. The intraoperative endoscopy has been proposed as a tool to measure the adequacy of the myotomy. To the best of our knowledge, there is no previous report of intraoperative endoscopy during LHM in Indonesia.Case Presentation: A 30-year-old female patient complained of progressive dysphagia and major weight loss due to esophageal achalasia for the last two months. She underwent LHM after a week of preoperative nutritional support. The endoscopic was conducted after the myotomy to ensure the adequacy of the myotomy and prevent excessive myotomy.Conclusion: The use of intraoperative endoscopy offers many advantages for LHM. It ensures adequate myotomy, thereby minimizing the risk of repeat or additional procedures. Moreover, endoscopy can help identify mucosal perforation. We propose using an intraoperative endoscopy as a routine procedure for LHM.
Case Report: Early Recognition and Repair of Distal Iatrogenic Ureteral Injury During Laparoscopic Rectal Surgery Mughni, Abdul; Fuadi, Ahmad Fathi; Daniswara, Nanda
Diponegoro International Medical Journal Vol 2, No 2 (2021): December
Publisher : Faculty of Medicine, Diponegoro University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/dimj.v2i2.12259

Abstract

Background: Ureteral injury is an uncommon complication of the colorectal procedure. The colorectal procedure is the second most common cause of ureteral injury. The laparoscopic approach for colorectal surgery has contributed to the increase of ureteral injury. Delayed diagnosis of the iatrogenic ureteral injury is associated with higher morbidity. However, the early diagnosis of ureteral injury during the operation is difficult. We presented an early recognition and laparoscopic repair of iatrogenic ureteral injury during laparoscopic rectal cancer surgery cases and the strategy for recognizing and managing that injury for the surgeon.Case Presentation: A Male, 34 years old, had an iatrogenic ureteral injury during laparoscopic low anterior resection for rectal cancer. The left distal ureter was transected by an energy device. The diagnosis of ureteral injury was prompt. The repair of the ureter was done endo-laparoscopically. The patient had an uneventful recovery and was discharged on day 6 after surgery.Conclusion: The iatrogenic ureteral injury, although uncommon, is a serious complication of laparoscopic colorectal surgery. Direct visual identification of the distal ureter is mandatory in every rectal surgery. The iatrogenic ureteral injury is not an indication for open conversion when there is an adequate resource to do the endo-laparoscopic ureteral repair.
Co-Authors Abdul Mughni Mahfuddin, Ahmad Za'im Muhtar Nanda Daniswara, Nanda