Review

Authors: Virgiliu-Mihail Prunoiu, Marian Augustin Marincaş, Eugen Brătucu...

The world of surgery has been concerned with idiopathic retroperitoneal fibrosis (RPF) ever since 1948, when J. K. Ormond published the first case of ureteral stenosis following a retroperitoneal scleroinflammatory process due to unknown reasons. Until 1960, 82 such cases were reported in the literature. The authors present two new cases of RPF, located exclusively in the pelvic (subperitoneal) compartment of the retroperitoneal space. The literature on this subject is reviewed, current etiological theories are mentioned and treatment opportunities are discussed.

Topics: Humans; Pelvis; Retroperitoneal Fibrosis; Retroperitoneal Space

PubMed: 33638333
DOI: 10.21614/chirurgia.116.1.117

Authors: Carlos Alventosa Mateu, Génesis Aurora Castillo López, Cecilia Albert Antequera...

Schwannoma is a mesenchymal tumor that is mainly located in the peripheral nerves or the central nervous system. Its retroperitoneal location is rare and commonly asymptomatic. Thus, it is usually diagnosed when imaging tests are performed for other purposes. The clinical course of Schwannoma is benign but it also has malignant potential. Therefore, surgical resection is the treatment of choice. The definitive diagnosis is anatomopathological. In this context, we present a patient with retroperitoneal Schwannoma.

Topics: Humans; Neurilemmoma; Retroperitoneal Neoplasms; Retroperitoneal Space

PubMed: 29931989
DOI: 10.17235/reed.2018.5569/2018

Authors: Jon Bjarnason, Luis Fernando Bazan Asencios, Hjalti Mar Thorisson...

A 50-year old male presented to our emergency department with sudden abdominal pain. Upon arrival he was diaphoretic, pale and tachycardic. A CT showed retroperitoneal hemorrhage with suspected tumor at the left adrenal gland. He was quickly stabilized with intravenous fluids and blood transfusion. Rebleed occurs roughly a week after discharge and a new CT showed a visceral pseudoaneurysm from the left middle adrenal artery. The pseudoaneurysm was embolized and the patient discharged in good condition. Follow-up MRI depicted reabsorption of the hematoma and no adrenal tumor. Thus, the etiology of the previous retroperitonal hemorrhage is considered spontaneous.

Topics: Male; Humans; Middle Aged; Aneurysm, False; Retroperitoneal Space; Hemorrhage; Hematoma; Adrenal Glands

PubMed: 37233620
DOI: 10.17992/lbl.2023.05.744

Authors: Junemoe Jeong, Jonghyeok Ko, Hyunjoo Lim...

OBJECTIVE

To develop and describe a laparoscopic retroperitoneal access technique, investigate working space establishment, and describe the surgical anatomy in the retroperitoneal space as an initial step for clinical application of retroperitoneal laparoscopy in dogs.

STUDY DESIGN

Cadaveric and experimental study.

ANIMALS

Cadaveric (n=8) and healthy (n=6) adult dogs.

METHODS

The retroperitoneal access technique was developed in 3 cadavers based on the human technique and transperitoneal observation. Its application and working space establishment with carbon dioxide (CO ) insufflation alone was evaluated in 5 cadavers by observing with a transperitoneal telescope and in 6 live dogs by repeated computed tomography (CT) scans at pressure of 0, 5, 10, and 15 mmHg. Recordings of retroperitoneoscopy as well as working space volume and linear dimensions measured on CT images were analyzed.

RESULTS

Retroperitoneal access and working space establishment with CO insufflation alone were successfully performed in all 6 live dogs. The only complication observed was in 1 dog that developed subclinical pneumomediastinum. As pressure increased, working space was established from the ipsilateral to the contralateral side, and peritoneal tearing eventually developed. Working space volume increased significantly from 5 mmHg and linear dimensions increased significantly from 0 to 10 mmHg. With pneumo-retroperitoneum above 5 mmHg, retroperitoneal organs, including kidneys and adrenal glands, were easily visualized.

CONCLUSION

The retroperitoneal access technique and working space establishment with CO insufflation starting with 5 mmHg and increasing to 10 mmHg provided adequate working space and visualization of retroperitoneal organs, which may allow direct access for retroperitoneal laparoscopy in dogs.

Topics: Animals; Cadaver; Carbon Dioxide; Dogs; Insufflation; Laparoscopy; Male; Pilot Projects; Pressure; Retroperitoneal Space

PubMed: 27731512
DOI: 10.1111/vsu.12571

Review

Authors: T Christopher Windham, Peter W T Pisters

BACKGROUND

The evaluation and treatment of retroperitoneal sarcomas are challenging because the tumors are relatively rare and frequently present with advanced disease in an anatomically complex location.

METHODS

We reviewed the literature on experience in the management of retroperitoneal sarcomas, and we present our own experience in the treatment of these tumors.

RESULTS

The identification of prognostic factors other than the adequacy of resection has been inconsistent. Due to a lack of associated symptoms, retroperitoneal sarcomas smaller than 5 cm are rare. Computed tomography is the most useful tool in the evaluation of retroperitoneal tumors. Surgery, radiation therapy, and chemotherapy are treatment options, but the most important factor in the treatment of primary tumors is complete surgical resection. The role of neoadjuvant and adjuvant therapies is not defined and should be considered within the context of clinical trials.

CONCLUSIONS

Early referral of patients with retroperitoneal soft tissue tumors will help to ensure that they will receive the benefits of multidisciplinary evaluation and treatment of their disease and ready access to clinical trials.

Topics: Antineoplastic Agents; Humans; Liver Neoplasms; Lung Neoplasms; Neoplasm Recurrence, Local; Prognosis; Radiotherapy; Retroperitoneal Neoplasms; Retroperitoneal Space; Sarcoma

PubMed: 15668651
DOI: 10.1177/107327480501200105

Authors: YuLong Xu, ChunJuan Ye, Bing Tan...

This paper investigates the correlation between the degree and severity of CT inflammatory infiltration in the retroperitoneal space of acute pancreatitis (AP). A total of 113 patients were included based on diagnostic criteria. The general data of the patients and the relationship between the computed tomography severity index (CTSI) and pleural effusion (PE), involvement, degree of inflammatory infiltration of retroperitoneal space (RPS), number of peripancreatic effusion sites, and degree of pancreatic necrosis on contrast-enhanced CT at different times were studied. The results showed that the mean age of onset in females was later than that in males; 62 cases involved RPS to varying degrees, with a positive rate of 54.9% (62/113), and the total involvement rates of only the anterior pararenal space (APS); both APS and perirenal space (PS); and APS, PS, and posterior pararenal space (PPS) were 46.9% (53/113), 53.1% (60/113), and 17.7% (20/113), respectively. The degree of inflammatory infiltration in the RPS worsened with the increase in CTSI score; the incidence of PE was higher in the group greater than 48 hours than in the group less than 48 hours; necrosis >50% grade was predominant (43.2%) 5 to 6 days after onset, with a higher detection rate than other time periods ( < 0.05). Thus, when the PPS was involved, the patient's condition can be treated as severe acute pancreatitis (SAP); the higher the degree of inflammatory infiltration in the retroperitoneum, the higher the severity of AP. Enhanced CT examination 5 to 6 days after onset in patients with AP revealed the greatest extent of pancreatic necrosis.

Topics: Male; Female; Humans; Pancreatitis, Acute Necrotizing; Retroperitoneal Space; Acute Disease; Tomography, X-Ray Computed; Computers

PubMed: 37113247
DOI: 10.1155/2023/7492293

Authors: Riccardo Lombardo, Raul Martos, Maria J Ribal...

INTRODUCTION

In the past years, several authors have focused on the role of retroperitoneoscopic laparoscopy in the treatment of urological diseases. Aim of our study is to systematically review the available literature on retro-peritoneoscopic laparoscopy in urology.

EVIDENCE ACQUISITION

A systematic review of the literature using the Medline, Scopus, and Web of Science databases for relevant articles published until June 2018 was performed using both the Medical Subjects Heading and free test protocols. The MeSH search was conducted by combining the following terms: "retroperitoneoscopy," "posterior laparoscopy," "retroperitoneoscopic." Only randomized clinical trials were included in the analysis. Risk of bias assessment and forest plots were used to summarize data.

EVIDENCE SYNTHESIS

Nine RCTs on simple, partial and radical nephrectomy, pyeloplasty, ureterolithotomy and nephrolithotomy comparing RP to other techniques were included in the analysis. Retroperitoneoscopic approach in simple or radical nephrectomy is to be considered a valid alternative to transperitoneal laparoscopic approach. Outcomes and safety profiles (6-8% conversion rate) are similar and the approach depends on surgeon's preferences. Randomized studies analyzing retroperitoneoscopic pyeloplasty showed better results in terms of perioperative morbidity (tramadol use: 147 vs. 179 mg, P=0.002) and return to normal activities when compared to either anterior laparoscopic either to minimally invasive open approach. Two randomized studies have confirmed the efficacy (stone-free rate: 94%) and safety (no Clavien-Dindo >II complications) of ureterolithotomy and nephrolithotomy (stone-free rate: 95%) in the management of large renal and ureteral stones.

CONCLUSIONS

Retroperitoneoscopic approach in urological diseases is a valid alternative to the anterior approach. Evidence suggest lower morbidity for the retroperitoneoscopic approach however technical complexity may limit its widespread.

Topics: Humans; Kidney; Laparoscopy; Randomized Controlled Trials as Topic; Retroperitoneal Space; Treatment Outcome; Urologic Surgical Procedures

PubMed: 30607927
DOI: 10.23736/S0393-2249.18.03235-6

Review

Authors: Owen S Glotzer, Gabrielle Rieth, Amanda Kistler...

OBJECTIVE

The left retroperitoneal approach to the aorta is a well-established technique for aortic exposure. The right retroperitoneal approach to the aorta is performed less commonly, and the outcomes remain unknown. This study aimed to evaluate the outcomes of right retroperitoneal aortic-based procedures and to determine its utility in aortic reconstruction when faced with hostile anatomy or infection in the abdomen or left flank.

METHODS

A retrospective query of a vascular surgery database from a tertiary referral center was performed for all retroperitoneal aortic procedures. Individual patient charts were reviewed, and data were collected. Demographics, indications, intraoperative details, and outcomes were tabulated.

RESULTS

From 1984 through 2020, there have been 7454 open aortic procedures; 6076 were retroperitoneal-based, and 219 of which were performed from the right retroperitoneal approach (Rrp). Aneurysmal disease was the most common indication (48.9%), and graft occlusion was the most common postoperative complication (11.4%). The average aneurysm size was 5.5 cm, and the most common reconstruction was with a bifurcated graft (77.6%). Average intraoperative blood loss was 923.8 mL (range, 50-6800 mL; median, 600 mL). Perioperative complications occurred in 56 patients (25.6%) for a total of 70 complications. Perioperative mortality occurred in two patients (0.91%). The 219 patients treated with Rrp required 66 subsequent procedures in 31 patients. These included 29 extra-anatomic bypasses, 19 thrombectomies/embolectomies, 10 bypass revisions, 5 infected graft excisions, and 3 aneurysm revisions. Eight Rrp eventually underwent a left retroperitoneal approach for aortic reconstruction. Fourteen patients with a left-sided aortic procedure required a Rrp.

CONCLUSIONS

The right retroperitoneal approach to the aorta is a useful technique in the setting of prior surgery, anatomic abnormality, or infection that complicates the use of other more frequently employed approaches. This review demonstrates comparable outcomes and the technical feasibility of this approach. The right retroperitoneal approach to aortic surgery should be considered a viable alternative to left retroperitoneal and transperitoneal access in patients with complex anatomy or prohibitive pathology for more traditional exposure.

Topics: Humans; Aorta, Abdominal; Retrospective Studies; Retroperitoneal Space; Abdomen; Vascular Surgical Procedures; Aortic Aneurysm, Abdominal

PubMed: 36889607
DOI: 10.1016/j.jvs.2023.02.013

Review

Authors: Marcelo Hisano, Fabio Carvalho Vicentini, Miguel Srougi...

Since the first laparoscopic adrenalectomy, the technique has evolved and it has become the standard of care for many adrenal diseases, including pheochromocytoma. Two laparoscopic accesses to the adrenal have been developed: transperitoneal and retroperitoneal. Retroperitoneoscopic adrenalectomy may be recommended for the treatment of pheochromocytoma with the same peri-operative outcomes of the transperitoneal approach because it allows direct access to the adrenal glands without increasing the operative risks. Although technically more demanding than the transperitoneal approach, retroperitoneoscopy can shorten the mean operative time, which is critical for cases with pheochromocytoma where minimizing the potential for intra-operative hemodynamic changes is essential. Blood loss and the convalescence time can be also shortened by this approach. There is no absolute indication for either the transperitoneal or retroperitoneal approach; however, the latter procedure may be the best option for patients who have undergone previous abdominal surgery and obese patients. Also, retroperitoneoscopic adrenalectomy is a good alternative for treating cases with inherited pheochromocytomas, such as multiple endocrine neoplasia type 2A, in which the pheochromocytoma is highly prevalent and frequently occurs bilaterally.

Topics: Adrenal Gland Neoplasms; Adrenalectomy; Follow-Up Studies; Humans; Laparoscopy; Pheochromocytoma; Retroperitoneal Space

PubMed: 22584723
DOI: 10.6061/clinics/2012(sup01)27

Review

Authors: Felix Peisen, Wolfgang Maximilian Thaiss, Kaspar Ekert...

BACKGROUND

 Retroperitoneal fibrosis is a rare disease with an incidence of 0-1/100 000 inhabitants per year and is associated with chronic inflammatory fibrosis of the retroperitoneum and the abdominal aorta. This article sheds light on the role of radiological imaging in retroperitoneal fibrosis, names various differential diagnoses and provides an overview of drug and surgical treatment options.

METHODS

 A literature search for the keywords "retroperitoneal fibrosis" and "Ormond's disease" was carried out in the PubMed database between January 1, 1995 and December 31, 2019 (n = 1806). Mainly original papers were selected, but also reviews, in English and German language, with a focus on publications in the last 10 years, without excluding older publications that the authors believe are relevant to the topic discussed in the review (n = 40).

RESULTS AND CONCLUSION

 Ormond's disease is a rare but important differential diagnosis for nonspecific back and flank pain. Imaging diagnostics using CT or MRI show a retroperitoneal mass, which must be differentiated from lymphoma, sarcoma, multiple myeloma and Erdheim-Chester disease. Patients have an excellent prognosis under adequate therapy. FDG-PET/CT or FDG-PET/MRT should be considered as potential modalities, as hybrid imaging can evaluate both the morphological changes and the inflammation.

KEY POINTS

  · Ormond's disease is a differential diagnosis for nonspecific back and flank pain.. · Radiological imaging is essential and the gold standard in the diagnosis and follow-up of RPF.. · Patients have an excellent prognosis under adequate therapy..

CITATION FORMAT

· Peisen F, Thaiss WM, Ekert K et al. Retroperitoneal Fibrosis and its Differential Diagnoses: The Role of Radiological Imaging. Fortschr Röntgenstr 2020; 192: 929 - 936.

Topics: Aorta, Abdominal; Back Pain; Diagnosis, Differential; Flank Pain; Humans; Magnetic Resonance Imaging; Retroperitoneal Fibrosis; Retroperitoneal Space; Tomography, X-Ray Computed

PubMed: 32698236
DOI: 10.1055/a-1181-9205