Chirurgia最新文献

{"title":"A Totally Laparoscopic Colectomy is Feasible for Acute Complicated Appendicitis with Necrotic Appendiceal Base in the Emergency Setting.","authors":"Giulio M Mari, Jacopo Crippa, Francesca Roufael, Richard Sassun, Emanuele Di Fratta, Angelo Miranda, Carmelo Magistro, Angelo Guttadauro, Barbara Vignati, Martino Gerosa, Mauro Santonocito, Dario Maggioni","doi":"10.21614/chirurgia.3065","DOIUrl":"10.21614/chirurgia.3065","url":null,"abstract":"<p><p><b>Introduction:</b> Acute appendicitis remains one of the most common surgical emergencies worldwide. Complicated acute appendicitis may present as perforated or gangrenous appendicitis with a compromised appendiceal base. This is a challenging scenario for surgeons that may require, in some cases, an ileocolic resection. This study aims to demonstrate the advantages and efficacy of a minimally invasive approach to complicated appendicitis requiring ileocolic resection. <b>Materials and Methods:</b> We reviewed patients who underwent extended resection for complicated acute appendicitis at our hospital from January 2022 to May 2024. Baseline, preoperative, intraoperative and postoperative features were analyzed. <b>Results:</b> During the study period, 15 patients with acute appendicitis required laparoscopic extended resection. Nine (56.2 %) underwent ileocecal resection, and 6 (43.8%) underwent right colectomy. All patients had an intracorporeal side to side, isoperistaltic 60 mm mechanical anastomosis. Mean length of stay was 7 Ã+- 1.3 days with no CD III and IV complications. No postoperative abdominal abscesses or anastomotic leaks occurred. <b>Conclusions:</b> Totally laparoscopic approach is a safe procedure for patients with complicated appendicitis requiring ileocolic resection.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"89-95"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572247","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":"Adenocarcinoma of the Interposed Colon Graft for Esophageal Substitution-Point of View from a Tertiary Center in Esophageal Surgery and Review of Literature.","authors":"Adrian Constantin, Cristian Gelu Rosianu, Florin Achim, Anthony Rasuceanu, Alexandru Rotariu, Alex-Claudiu Moraru, Dragos-Viorel Scripcariu, Dragos Predescu","doi":"10.21614/chirurgia.3093","DOIUrl":"10.21614/chirurgia.3093","url":null,"abstract":"<p><p>Resection or bypass surgery for benign or malignant esophageal pathologies presents multiple challenges, which is why it is addressed to centers of digestiveexcellence. One such challenge is the restoration of the continuity of the digestive tract, the colon being an important option for esophageal substitution. Lon-term follow up of patients with colon reconstruction is essentially related to digestive-nutritional problems. An exceptional situation, by its particularity and evolution, is the appearance of pre-malignant lesions (polyps) or frankly malignant lesions of the colon graft. The aim of the article was to draw attention to the risk of such a long-term complication, unforeseen, difficult to manage diagnostically and therapeutically. At the same time, the limited data in the literature, usually case reports, leave a series of unanswered questions for the attending physician, both in terms of etiology and case management. That is why we wanted to review the literature, identify common elements with other authors, so as to seek working hypotheses and identify mechanisms or, at least, to signal such a possible complication.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"15-31"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572250","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":"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":"120 1","pages":"96-102"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572285","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":"Gastroesophageal Reflux Disease - A Review of Important Management Components.","authors":"Karl-Hermann Fuchs, Alexander Hann, Alexander Meining","doi":"10.21614/chirurgia.3090","DOIUrl":"10.21614/chirurgia.3090","url":null,"abstract":"<p><p><b>Background:</b> Gastroesophageal Reflux Disease (GERD) has a persisting high prevalence in western industrial countries and a rising prevalence in some asian industrial societies. Management of the disease, i.e. the multimodal care for the affected patients consists of the application of a definition of GERD to clearly define the cohort, using a systematic and differentiated diagnostic work-up as well as using selection criteria for conservative versus interventional and surgical therapy and long-term accompaniment. The purpose of this manuscript is a review of the information in literature on items involved in the current management of GERD and their clinical application. <b>Methods:</b> A list of items was established with all components necessary for the multimodal management of patients with GERD. A literature search was performed using the term [management of GERD] or [GERDmanagement] in medline pubmed.gov (USA). All abstracts were evaluated for their usefulness regarding the aim of the study, those with a different focus on GERD-issues were excluded. <b>Results:</b> Initially 8 items were identified necessary for the multimodal management of GERD-patients. In total, 2193 abstracts were found between 2017 and 2023, which were evaluated and 53 full articles were analyzed. Out of these 53 publications with the correct focus on GERD-management, 34 were excluded for not providing at least 4 of the available 8 items of the complete spectrum of GERD-management. Finally, 19 reports were selected for final assessment. Remarkably, 16 out of 19 publications used either a symptom questionnaire or the Montreal classification, while others used esophageal acid exposure or esophagitis for defining the presence of GERD. Regarding suggestions for a multimodal therapeutic concept, only 9 publications reported on all available therapeutic management options of GERD. Most publications described conservative therapy, while 9 articles included surgical procedures as an option in the overall GERD-management. <b>Conclusions:</b> GERD cannot be handled as just one disease, but should be considered as a multi-factorial disease consisting of several subgroups of GERD-patients with different phenotypes. All these different sub-groups of the disease may need their individual management options. Only half of publications on GERD-management provided the complete spectrum of involved management components.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"5-14"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572281","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 Impact of Minimally Invasive Surgery in Patients with Colorectal Cancer and Type 2 Diabetes Mellitus.","authors":"Nicoleta Leopa, Mihaela Pundiche, Cristina Dan, Teodor Ștefan Niţu, Stefan Paitici, Andreea Badea, Alina Doina Nicoară, Răzvan Cătălin Popescu","doi":"10.21614/chirurgia.3097","DOIUrl":"10.21614/chirurgia.3097","url":null,"abstract":"<p><p><b>Background:</b> Laparoscopic surgery is now widely recognized as a very safe and effective standard treatment for colorectal cancer as compared with laparotomy. Diabetes causes significant mortality and morbidity in the general population, and in particular in patients who associate an oncological pathology. In the postoperative period, diabetic patients have a significantly higher risk of developing important complications. The aim of this study was to analyze the impact of minimally invasive surgery in patients with colorectal cancer and type 2 diabetes mellitus. <b>Methods:</b> Between January 2018-2022, 482 patients diagnosed with colorectal cancer were enrolled in the study, of whom 52 were eligible for inclusion. General characteristics and the presence of diabetes before colon cancer diagnosis were identified. Kaplan-Meier analyses were performed according to type of surgery, gender, stage of disease, and associated comorbidities. <b>Results:</b> Fifty-two patients were included in the study, divided into two groups: 24 underwent laparoscopic surgery and 28 open surgery. Postoperative recovery was faster in patients who underwent laparoscopic surgery, this being also evidenced by a lower number of postoperative hospitalization days (6.67+-1.97 vs 9.21+-2.36, p 0.001). Regarding postoperative complications, patients with open surgery, had higher rate of minor and major complications according to the Clavien-Dindo classification (67.9% vs 25%), and the long-term survival of patients who underwent laparoscopic surgery was higher. <b>Conclusions:</b> Laparoscopic surgery is recommended for patients with colorectal cancer and type 2 diabetes, the patients having minimal postoperative complications and a faster postoperative recovery period.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"71-78"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572224","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":"Surgical Management of Rectal Cancer: Does Robotic Surgery Emerge as the Best Alternative? A Narrative Review.","authors":"Maria-Manuela Răvaş, Virgiliu-Mihail Prunoiu, Eugen Brătucu, Marian Marincaş, Laurenţiu Simion, Laura-Maria Manea, Mircea-Nicolae Brătucu","doi":"10.21614/chirurgia.3079","DOIUrl":"10.21614/chirurgia.3079","url":null,"abstract":"<p><p>Rectal cancer is one of the most frequently diagnosed malignancies, associated with high morbidity and mortality, which justify the constant interest in fine-tuning the available therapeutic methods and developing new ones. The preference for one surgical technique over another is highly dependent on the stage, the location of the tumor, other patient-related factors and the experience of the surgical team. This article aims to offer a comprehensive review of the surgical modalities utilized at the present time for the curative treatment of rectal cancer, as well as the future directions in this field, pointing out the latest progress and the most recent shifts in paradigm in the management of rectal cancer. The evolution of open surgery, laparoscopy, robotic surgery, and transanal techniques is described in chronological fashion, highlighting the advantages and disadvantages of each procedure. Although open surgery remains the gold standard for emergency situations such as occlusion or massive bleeding, minimally invasive surgery has gained ground over the past decade due to its benefits - faster discharge, lower infection rates, better short-term outcomes, while demonstrating similar oncological long term outcomes as in the traditional surgical approach. The main disadvantage is strongly connected with the training process, especially with gaining experience in complicated cases, as well as the total cost of equipment and maintenance. While robotic surgery has been lately successfully implemented in advanced or/and recurrent low and medium rectal cancer, laparoscopy remains the most utilized minimally invasive modality which has the undeniable advantage of shorter operating time. Additionally, one of the most discussed topics comprises the newly developed transanal techniques which offer an elegant solution for distal rectal tumors, especially in obese patients or with narrow pelvises. Continuous optimization and new developments of surgical techniques in rectal cancer lead to accomplishing the goals of precision medicine.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"48-60"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572223","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":"Prognostic Scoring in Rectal Cancer Surgery: Evaluating the Efficacy of E-PASS, POSSUM, CR-POSSUM and ACPGBI in Risk Assessment, Complications Analysis, and Outcome Improvement - Findings from a Single-Center Study.","authors":"Valentin Calu, Catalin Piriianu, Adrian Miron, Elena-Adelina Toma, Octavian Enciu, Mugur Ardelean, Valentin Titus Grigorean","doi":"10.21614/chirurgia.3098","DOIUrl":"10.21614/chirurgia.3098","url":null,"abstract":"<p><p><b>Background:</b> Prognostic scoring systems are critical for assessing preoperative risk and forecasting outcomes in rectal cancer surgery. This study evaluates the effectiveness of four scoring systems - Estimation of Physiologic Ability and Surgical Stress (E-PASS), Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), Colorectal-POSSUM (CR-POSSUM), and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) - in predicting postoperative complications and mortality. <b>Methods:</b> A retrospective study was conducted involving 67 patients who underwent surgery for rectal cancer. The scoring systems were assessed concerning postoperative outcomes, including complications, morbidity, and 30-day mortality rates. Statistical analyses included t-tests, chi-square tests, and logistic regression. <b>Results:</b> Patients with complications (n = 39) demonstrated significantly higher scores across all systems. The Comprehensive Risk Score (CRS) derived from E-PASS (11.43 versus 8.95, p = 0.001) and the ACPGBI score (1.95 versus 1.27, p = 0.0005) demonstrated the most significant correlation with complications. Elevated physiological and operative scores correlated with increased morbidity, underscoring their prognostic importance. <b>Conclusions:</b> Scoring systems such as E-PASS, POSSUM, CR-POSSUM, and ACPGBI effectively stratify the risk associated with rectal cancer surgery. Clinical integration enhances the identification of high-risk patients, which informs interventions designed to optimize outcomes.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"61-70"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572221","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 Treatment of Pancreatic Neuroendocrine Tumors - A Retrospective Single-Centre Study.","authors":"Mihaela-Madalina Gavrilescu, Ionut Hutanu, Dragos Viorel Scripcariu, Bogdan Filip, Maria-Gabriela Anitei, Iulian Radu, Viorel Scripcariu","doi":"10.21614/chirurgia.3095","DOIUrl":"10.21614/chirurgia.3095","url":null,"abstract":"<p><p><b>Introduction:</b> Pancreatic neuroendocrine tumors (PNETs) are uncommon cancers, but their overall incidence seems to be on the rise, possibly due to better detection with advancements in cross-sectional imaging techniques. <b>Methods:</b> This study consists of a retrospective analysis of PNET patients treated in the First Surgical Oncology Clinic over a period of 10 years. The patient files were evaluated, and the following parameters were taken into consideration: gender, age, primary tumor site, extension of the disease, metastatic sites, the therapeutic approach, type of surgery, histopathological results, postoperative mortality, and morbidity. <b>Results:</b> Over the course of 10 years, there were 16 patients diagnosed with PNETs. Surgical interventions consisted in: pylorus-preserving pancreaticoduodenectomy in 5 cases, distal pancreatectomy in 3 cases, enucleation of the tumor in 4 cases, liver biopsy in 3 patients and one case in which choledochoduodenostomy and a liver biopsy were the treatment option. Mean length of stay was 10.6 days. In the study group, there were 4 cases that presented grade I-II complications (Clavien-Dindo). There was no case of postoperative or 30 days mortality. Conclusion: This study outlines the surgical management and clinicopathological findings of PNETs. Surgical therapy must be tailored to tumor and clinical characteristics.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"79-88"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572226","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":"Colorectal Pancreatic Metastases: A Three-Case Series and Literature Review.","authors":"Emil Matei, Silviu Ciurea, Vlad Herlea, Bogdan Mihail Dorobantu, Catalin Vasilescu","doi":"10.21614/chirurgia.3083","DOIUrl":"10.21614/chirurgia.3083","url":null,"abstract":"<p><p><b>Introduction:</b> Pancreatic metastases are very rare tumors comprising 2-5 % of all malignant tumors of the pancreas. Colorectal pancreatic metastases are rare - 1.7%. Clinical features: Three patients with colo-rectal pancreatic metastasis were resected in our departament. The immunohsitochemical examination was positive for colorectal origin. Extensive imagistic work-up excluded extrapancreatic disease and allowed the surgical resection. <b>Results:</b> Three patients with personal history of colorectal cancer (2 - colon, 1 -rectal) were diagnosed with isolated pancreatic metastasis (2 in the head and one in body). Standard pancreatic resections were performed (2 pancreatico-duodenectomies and one distal spleno-pancreatectomy). One patient with associated vascular resection died postoperatively. The other two developed extrapancreatic recurrence and only one was resected (alive and disease free); the other died under systemic therapy. <b>Conclusions:</b> Surgical resection is recommended in selected patients, surgically fit, with resectable oligometastatic disease, in high-volume center with experience in pancreatic surgery.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"117-124"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572260","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":"Recurrent Giant Pseudopolyp: Case Report and Review of the Literature.","authors":"Emanuele Calicis, Marion Culot, Etienne Veys, Aude Schillaci, Julie Frezin","doi":"10.21614/chirurgia.3043","DOIUrl":"https://doi.org/10.21614/chirurgia.3043","url":null,"abstract":"<p><p><b>Introduction:</b> we report the case of a recurrent giant pseudopolyp occurring in a patient without a history of inflammatory bowel disease (IBD), with an asymptomatic interval of nine years. Case Presentation: a 51-year-old Caucasian male with no relevant medical history was hospitalized for a subocclusive mass in the right colon, suspected to be neoplastic. He underwent a right hemicolectomy, and the histopathology revealed a giant pseudopolyp without malignancy. Follow-up for IBD was recommended but not completed. Nine years later, the patient presented with a similar clinical picture, and another mass was found at the site of the prior anastomosis. Surgical excision confirmed another giant pseudopolyp with no evidence of neoplasia. Conclusion: giant pseudopolyps, while often associated with IBD, can occur in patients without a prior inflammatory history. This case underscores the need to include pseudopolyps in the differential diagnosis of colonic masses, even in the absence of IBD, to avoid unnecessary surgical morbidity.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"119 6","pages":"721-724"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906657","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}