Chirurgia最新文献

{"title":"D3 Lymphadenectomy for Right Colon Cancer: Feasibility, Safety, and Early Outcomes from a District General Hospital in London.","authors":"Valentin Butnari, Timothy Jones, Ahmer Mansuri, Maitreyi Patel, Victor Kung, Saswata Banerjee, Nirooshun Rajendran, Joseph Huang, Richard Boulton, Sandeep Kaul","doi":"10.21614/chirurgia.3026","DOIUrl":"https://doi.org/10.21614/chirurgia.3026","url":null,"abstract":"<p><strong>Background and objectives: </strong>Observational studies suggest a link between D3 lymphadenectomy and improved disease-free survival in some colon cancer patients. However, high-quality randomized controlled trials are needed to confirm its advantage over D2 lymphadenectomy. Concerns about potential complications with D3 have limited its use outside of Japan. This study examines short-term outcomes following D3 lymphadenectomy for right-sided colon cancer compared to the established D2 procedure. <b>Materials and Methods:</b> This retrospective cohort single center study analyzed data on patients with right-sided colon cancer who underwent curative surgery within our healthcare trust between January 2019 and November 2022. Only patients treated by surgeons who routinely perform D3 lymphadenectomy were included for a homogenous study population. The decision to perform D3 was at the discretion of the operating surgeon. Data were collected from both paper charts and electronic medical records. Non-parametric statistical tests were used for data analysis. <b>Results:</b> A total of 214 patients met the criteria, with 170 undergoing D2 lymphadenectomy and 44 undergoing D3 lymphadenectomy. There were no significant differences between the groups in terms of surgery duration, blood loss, postoperative hemoglobin levels, or transfusion needs. Interestingly, the D3 group had a lower complication rate (25%) compared to the D2 group (41.2%). However, the D3 group also had a higher rate of lymph node spread (45.5% vs. 30.6% for D2) and more lymph nodes removed (19 [16, 25] vs. 23 [18, 28]). Importantly, both groups achieved similar complete tumour removal rates. <b>Conclusions:</b> This study suggests D3 lymphadenectomy for right-sided colon cancer might be safe with potential benefits, especially for younger patients with suspected lymph node involvement. However, the limited sample size necessitates larger, randomized trials to confirm these findings and potentially establish D3 lymphadenectomy as standard care.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 4","pages":"359-372"},"PeriodicalIF":0.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Lateral Hysteropexy versus Hysterosacropexy in Women with Stage III Uterine Prolapse.","authors":"Irina Niţu, Vasile Sârbu, Silvia Savin, Neacşu Sabina, Silvia Șerban, Stere Popescu, Teodor Ștefan Niţu, Mihaela Pundiche, Răzvan Cătălin Popescu, Nicoleta Leopa","doi":"10.21614/chirurgia.119.eC.3015","DOIUrl":"https://doi.org/10.21614/chirurgia.119.eC.3015","url":null,"abstract":"<p><p><b>Background:</b> Minimally invasive techniques in gynecological pathology have well-known benefits, the \"gold standard\" of uterine prolapse being currently managed laparoscopically. Laparoscopic lateral hysteropexy and hysterosacropexy are surgical techniques that can be performed for uterine prolapse. Laparoscopic management of such cases is recommended, but requires well-trained teams in laparoscopic surgery. <b>Methods:</b> This study is a prospective analysis of patients who required surgical treatment for stage III uterine prolapse, hospitalized in the Surgery Department of Constanta County Hospital, for which laparoscopic lateral hysteropexy or laparoscopic hysterosacropexy was performed. <b>Results:</b> Between 2016-2020, 61 patients were hospitalized with stage III uterine prolapse that required surgery. All patients underwent laparoscopic surgery. Symptomatology was dominated by urinary incontinence (50%, 44.89%) and obstructive defecation (16.66%, 18.36%). Intraoperative complications were encountered in 33.3% of cases undergoing laparoscopic hysterosacropexy and in 8.16% undergoing laparoscopic lateral hysteropexy. At one year, the recurrence rate was 2.04% for patients who underwent lateral hysteropexy and 8.33% for patients who underwent hysterosacropexy. No patient had a recurrence at the 3-year visit. <b>Conclusions:</b> Laparoscopic lateral hysteropexy is emerging as an appropriate, safe, and effective procedure to treat advanced apical prolapse that requires further clinical attention and development to fully understand its surgical place in the treatment of pelvic defects.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 eCollection","pages":"1-7"},"PeriodicalIF":0.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Banaras Convention: A Safe Reliable Technique for Axillary Dissection by Lateral exposure of Latissimus Dorsi Pedicle.","authors":"Mayank Tripathi, Kumar Vineet, Piyush K Shukla, Ravinder Kumar, Nitesh Joshi, Neha Mishra","doi":"10.21614/chirurgia.3021","DOIUrl":"https://doi.org/10.21614/chirurgia.3021","url":null,"abstract":"<p><p>Breast cancer is rising among women in India. Most of the cases are presented at the locally advanced stage where axillary dissection is needed. In this article, we have described our approach of axillary dissection in the technically challenging high nodal burden axillas.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 4","pages":"440-444"},"PeriodicalIF":0.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends for Admission and Mortality in Peptic Ulcers at a Tertiary Referral Hospital During the 2017-2021 Period.","authors":"Sergiu Marian Cazacu, Valeriu Marian Surlin, Ion Rogoveanu, Alexandru Goganau, Vlad Florin Iovanescu, Alexa Lorena Ghinea, Mircea Parscoveanu, Emil Moraru, Alexandru-Marian Vieru, Dan Cartu","doi":"10.21614/chirurgia.2923","DOIUrl":"https://doi.org/10.21614/chirurgia.2923","url":null,"abstract":"<p><p><b>Background:</b> The incidence of peptic ulcers has decreased during the last decades; the COVID-19 pandemic may have influenced the peptic ulcer hospitalizations. The study aimed to assess the admissions and mortality for complicated and uncomplicated peptic ulcers and the influence of the pandemic period. Material and <b>Methods:</b> We performed an observational study at a tertiary academic center, including all patients admitted for peptic ulcers between 2017-2021. We evaluated the admissions for complicated and uncomplicated ulcers and risk factors for mortality. <b>Results:</b> 1416 peptic ulcers were admitted, with an equal proportion of gastric and duodenal ulcers; most patients were admitted for bleeding (66.7%), and perforation (17.3%). We noted a decreasing trend for peptic bleeding ulcer (PUB) and uncomplicated ulcer admissions during 2020-2021, while for perforation no significant variation was recorded; a decreasing mortality in PUB was noted from 2017 to 2020. Admissions for bleeding peptic ulcer have decreased by 36.6% during the pandemic period; the mortality rate was similar. Admissions for perforated peptic ulcer have decreased by 14.4%, with a higher mortality rate during the pandemic period (16.83 versus 6.73%). Conclusion: A decreasing trend for PUB admissions but not for perforated ulcers was noted. Admissions for PUB have decreased by more than 1/3 during the pandemic period, with a similar mortality rate. Admissions for perforated peptic ulcers have decreased by 1/7, with significantly higher mortality rates during the pandemic period.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 4","pages":"404-416"},"PeriodicalIF":0.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Challenge in Heterotopic Pancreas in the Ampulla of Vater with Obstructive Jaundice - A Case Report and Literature Review.","authors":"Robert Ciortan, Loai Alshantti, Adrian Cîmpeanu, Mihai Toma, Monica Hortopan, Alexandru Procop, Gabriel Mitulescu, Sorin Petrea, Camelia Diaconu, Bogdan Gaspar, Lucian Pop, Valentin Varlas, Adrian Hasegan, Cristina Martac, Marilena Stoian, Anca Zgura, Gabriel Petre Gorecki, Irina Balescu, Alexandru Ciulcu, Nicolae Bacalbasa","doi":"10.21614/chirurgia.119.eC.3001","DOIUrl":"10.21614/chirurgia.119.eC.3001","url":null,"abstract":"<p><p>Heterotopic pancreas is a rare congenital abnormality. The most common location is the stomach, duodenum and proximal jejunum. Rare locations are represented by the ampulla of Vater, esophagus, ileum, Meckel diverticulum, biliary tract, mesentery and spleen. We present the case of a 49 year old patient investigated for obstructive jaundice and diagnosed with an ampullar heterotopy of pancreas parenchyma, initially considered to be a malignant tumor. A Whipple pancreatoduodenectomy was performed with good postoperative evolution, the serum levels of bilirubin being normal after the first postoperative week.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 eCollection","pages":"1-5"},"PeriodicalIF":0.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Efficacy, and Long-Term Outcomes Between Pneumatic Dilation and Laparoscopic Heller Myotomy in Achalasia.","authors":"Abdullah Alkadour, Petre Hoara, Silviu Constantinoiu, Dragos Predescu, Rodica Birla, Cristina Gindea, Mircea Gheorghe, Madalina Mitrea-Tocitu, Eugenia Panaitescu, Roberta-Gabriela Velicu, Florin Achim","doi":"10.21614/chirurgia.2024.v.119.i.3.p.311","DOIUrl":"https://doi.org/10.21614/chirurgia.2024.v.119.i.3.p.311","url":null,"abstract":"<p><p><b>Introduction:</b> Achalasia is the most well-known motility disorder, characterized by the lack of optimal relaxation of the lower esophageal sphincter during swallowing and the absence of peristalsis of the esophageal body. Laparoscopic Heller esocardiomyotomy (LHM) and pneumatic dilation (PD) were the main treatment options for achalasia. Currently, the therapeutic methods are complemented by per-oral endoscopic myotomy (POEM). <b>Materials and Methods:</b> we performed a retrospective study, analyzing the data and evolution of 98 patients with achalasia, admited and treated in the General and Esophageal Surgery Clinic of the St. Mary Clinical Hospital-Bucharest between January 2016 and June 2023. The treatment was performed by PD in 25 cases and the majority LHM. The average duration of symptoms in the case of PD was 48 months, and 24 months in LHM. The patients were evaluated before and after the treatment procedures by the Eckardt clinical score and investigations such as timed barium esophagogram (TBO) and esophageal manometry. <b>Results:</b> Although patients had the same Eckardt score before treatment, a statistically significant decrease of the Eckardt score was obtained at the post-therapeutic evaluation after undergoing LHM compared to PD. Recurrence of symptoms was more frequent in the case of PD, requiring another therapeutic intervention. The cost of treatment, as well as the number of hospitalization days were reduced in the case of PD. <b>Conclusions:</b> The treatment of achalasia with LHM is more effective regarding recurrence of symptoms, even if it involves higher costs and a longer hospital stay compared to DP.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 3","pages":"311-317"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Surface: A Case Report of a Patient with Small Bowel Metastasis and Melanoma History. Diagnosis and Management.","authors":"Stefania Chipuc, Nicolae Bacalbasa, Anghel Rodica, Letitia Toma, Laura Iliescu, Cosmin Baciu, Anca Zgura","doi":"10.21614/chirurgia.119.eC.2992","DOIUrl":"10.21614/chirurgia.119.eC.2992","url":null,"abstract":"<p><p><b>Background:</b> Malignant melanoma (MM) is one of the most prevalent and deadliest forms of skin cancer, resulting from the malignant transformation of melanocytes. It accounts for approximately 1.7% of global cancer diagnoses and is the fifth most common cancer in the US. MM can metastasize to almost any part of the body, with early detection significantly improving prognosis. Case presentation: We report the case of an 81-year-old female with a history of malignant melanoma (primary lesion on the left calf) and various comorbidities. She presented with severe anemia of unknown origin. A CT scan was performed due to her medical history, revealing a circumferential, asymmetrical parietal thickening at the level of a hypogastric ileal loop. The lesion suggested a tumoral substrate. Subsequent colonoscopy showed no metastatic lesions, but surgical intervention confirmed a malignant melanoma ileal metastasis. The patient underwent laparoscopic segmental resection with favorable post-surgery outcomes. Histopathological examination of the resected tissue confirmed the diagnosis of small intestine secondary lesions from the malignant melanoma. Conclusion: This case underscores the necessity of considering metastatic melanoma in patients with a history of MM and vague gastrointestinal symptoms. Early and accurate diagnosis through advanced imaging and endoscopic techniques can significantly improve patient outcomes.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 eCollection","pages":"1"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar Melanoma with Sentinel Lymph Nodes in Multiple Basins - Case Report and Review of the Literature.","authors":"Dan Dumitrescu, Florin Bobircă, Mihaela Leventer, Traian Pătraşcu","doi":"10.21614/chirurgia.119.eC.2989","DOIUrl":"10.21614/chirurgia.119.eC.2989","url":null,"abstract":"<p><p>Intreduction: Melanoma is an extremely aggressive form of skin neoplasia, an important stage in the diagnostic and treatment is identifying the dissemination at the lymphatic level. For a more accurate staging, the sentinel lymph node biopsy technique is performed, which in most of the time addresses one, respectively 2 locations, but cases with sentinel nodes in 3 lymphatic basins have rarely been described. Case report: We present a case of melanoma located in the right lumbar region, which from the point of view of histopathological features has a Breslow index of 4.2 mm, classified in the pT4b stage. After the CT evaluation was performed, it was decided that there is indication for performing the sentinel lymph node technique and excision with a margin of safety. Scintigraphy revealed that sentinel lymph nodes were identified in 3 different regions, respectively the right axilla and bilateral inguinal. <b>Conclusions:</b> Melanoma located on the trunk can present different lymphatic routes for the sentinel lymph nodes, unlike that on the limbs where certain patterns are present. Identifying these lymph nodes in cases like this involves a challenge both from a diagnostic and surgical point of view.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 eCollection","pages":"1"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Anterior Notch Area for 3 Types of Notch Geometry, an Individualized Approach for Choosing the ACL Graft Size.","authors":"Eduard M Cernat, Andrei Neagu, Cezar Betianu, Drago-Eugen Georgescu, Adrian Barbilian, Loredana Sabina Cornelia","doi":"10.21614/chirurgia.119.eC.2991","DOIUrl":"https://doi.org/10.21614/chirurgia.119.eC.2991","url":null,"abstract":"<p><p><b>Background:</b> The intercondylar notch (ICN) is an important element of knee morphometry, in close relation to the anterior cruciate ligament (ACL). To find the average are of the anterior notch in each ICN specific shape (A-, W-, or U-shape). <b>Methods:</b> Magnetic resonance imaging (MRI) scans were independently analyzed by two experts, one orthopedic surgeon and one imaging physician. In all cases, the following measurements were done according to the existing definitions: ICN type, aICN area. <b>Results:</b> 65 cases (A-35.4%, W-26.2%, U-38,5%) were included in study; A and W notch types have smaller aICN areas, while U-type notch has bigger aICN area. Conclusion: The anterior intercondylar notch area varies significantly for each specific shape (A-, W, or U-shape), and does not corelates with height. This needs to be considered during ACL reconstruction, when choosing graft size.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 eCollection","pages":"1-10"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Management of Pelvic Organ Prolapse: A Case Series.","authors":"Irina Niţu, Vasile Sârbu, Silvia Savin, Neacşu Sabina, Silvia Șerban, Stere Popescu, Teodor Ștefan Niţu","doi":"10.21614/chirurgia.119.eC.3004","DOIUrl":"10.21614/chirurgia.119.eC.3004","url":null,"abstract":"<p><p><b>Background:</b> Pelvic static disorders have an important impact on patients' quality of life, constituting a real public health problem, despite the fact that they are not life-threatening. Minimally invasive procedures of pelvic organ prolapse has many advantages, laparoscopic hysteropexy and colpopexy being a standard with real benefits: minimal incisions, reduced postoperative complications, shorter hospital stay and a low recurrence rate. Laparoscopic management of such cases is recommended, but requires teams well trained in minimally invasive surgery. Case presentation: We presented a series of successful cases of two patients with grade III hysterocele, respectively vaginal vault prolapse, who were treated minimally invasively with a lateral laparoscopic hysteropexy, respectively lateral laparoscopic colpopexy. Given the well-known benefits of minimally invasive surgery, we chose laparoscopic surgery because of the smaller surgical impact and faster return to normal life. The surgical procedures were performed successfully, without complications, with rapid recovery, without recurrence. Conclusion: Hysteropexy and laparoscopic colpopexy are safe and effective surgical procedures in selected cases.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 eCollection","pages":"1-6"},"PeriodicalIF":0.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}