1.Iatrogenic Ureter Injuries: Eleven Years Experience in A Tertiary Hospital
Hans Alexander Mahendran ; Praveen Singam ; Christopher Ho ; Goh Eng Hong ; Tan Guan Hee ; Zuklifli Md Zainuddin
The Medical Journal of Malaysia 2012;67(2):169-172
Iatrogenic ureteric injuries are rare complications of
abdomino-pelvic surgery but associated with high morbidity
from infection and possible loss of renal function. A
successful repair is related to the timing of diagnosis, site of injury and method of repair. This study was a retrospective review of outcomes of iatrogenic ureteric injury and factors contributing to successful operative repair. Twenty consecutive cases referred to the Urology Unit of the UKM Medical Center during an 11-year period from 1998 to 2009 were reviewed. Thirteen patients were diagnosed intraoperatively and underwent immediate repair. Seven patients had delayed diagnosis but also underwent immediate repair.
In our series, there was no significant difference in outcome between injuries diagnosed intraoperatively versus injuries with delayed diagnosis. There was significant difference in the outcomes between methods of ureteric repair where ureter reimplantation via psoas hitch or Boari flap yielded better results than primary end-to-end anastomosis Three patients suffered loss of renal function from unsuccessful ureter repair. We conclude that all iatrogenic ureteric injury should be repaired immediately in the absence of overt sepsis. Ureter reimplantation using a Boari flap or psoas hitch is preferred to the end-to-end anastomosis especially when there is delayed diagnosis
2.A case of laparoscopic resection of myxoid liposarcoma of the greater omentum
Sze Li Siow ; Mohamad Hisham Faqihuddin ; Hans Alexander Mahendran,
The Medical Journal of Malaysia 2020;75(4):455-457
Primary omental liposarcoma is a rare clinical entity with less
than 20 cases being reported in the literature. Laparotomy has
been the traditional approach for resection, with no reports of
laparoscopic resection. A 39-year-old lady presented at the
Sarawak General Hospital, Kuching, Malaysia with a history
of a progressive, painless left upper quadrant abdominal
swelling for a year. CT scan showed a well-defined
heterogeneously enhancing cystic mass measuring
7.5x7.5x8.1cm with a poor plane with the adjacent greater
curvature of stomach and transverse colon. Upper and lower
endoscopy was normal. The tumour was completely dissected
from the adjacent transverse colon and removed
laparoscopically. Histopathological examination of the resected
specimen revealed a myxoid liposarcoma. She had an
uneventful recovery and was discharged well on the third postoperative day. She subsequently underwent adjuvant
chemotherapy and was well at 1-year follow-up with PET CT
showing no evidence of recurrence or metastases.