A 78-year-old patient with ochronosis has developed symptomatic aortic stenosis. He has undergone an aortic valve replacement that was highly complicated by a severe aortic calcification. The right coronary artery was sacrificed and bypassed in order to control a massive aortic root haemorrhage. The patient has presented a sternal dehiscence that required surgical revision. The sternal frailty was related to chronic corticotherapy in a patient with chronic spondylarthrosis. Cardiac ochronosis in the elderly may be associated to surgical complications related to severe aortic root calcifications and chronic corticotherapy for arthropathies. #

SSILRH is useful because the SAS can be enlarged for extraction of the specimen without compromising the cosmetic outcome. The mesocolic and mesenteric dissections are on the same axis as the access site. The intracorporeal anastomosis can be performed without traction. Finally, positioning of the operative table improves exposure of the operative field and allows the surgeon to maneuver the colon and small bowel intracorporeally.

Duodenal diverticula are relatively common and usually asymptomatic (95%). Their perforation is a rare but harmful event. Traumatic perforation is exceptional. We report the case of a patient with such a lesion following a blunt trauma secondary to a car accident, and review the literature. Clinical presentation is aspecific and diagnosis is based upon CT scan imaging. Surgery is the recommended treatment consisting of diverticulectomy with transverse duodenal closure of the duodenum associated with retroperitoneal drainage.

LAGBR can be safely performed through SAL. Thanks to this technique, the laparoscopic working triangulation is established as well as the ergonomic positions of the surgeon. Due the use of only reusable material, the cost of this SAL remains similar to multiport laparoscopy.

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