European Surgical Research最新文献

{"title":"Blockage of CX3CL1 Attenuates Platelet and Leukocyte Recruitment in Murine Hepatic I/R.","authors":"Dominik Funken,&nbsp;Alexandra Brüggemann,&nbsp;Konstantin Mende,&nbsp;Maximilian Lerchenberger,&nbsp;Markus Rentsch,&nbsp;Andrej Khandoga","doi":"10.1159/000524024","DOIUrl":"https://doi.org/10.1159/000524024","url":null,"abstract":"<p><strong>Introduction: </strong>The chemokine fractalkine (CX3CL1) is critically involved in the pathophysiology of different inflammatory diseases and myocardial ischemia-reperfusion (I/R). This study aimed to analyze the role of CX3CL1 in the activation of platelets and leukocytes during hepatic I/R.</p><p><strong>Methods: </strong>Under inhalation anesthesia, C57BL6 mice were subjected to warm hepatic I/R (90 min/240 min). The animals were pretreated either with a function-blocking anti-mouse CX3CL1 antibody or IgG control administered systemically before ischemia. Sham-operated animals served as controls (n = 7 each group). The inflammatory response and sinusoidal perfusion failure were evaluated by intravital microscopy. Hepatic transaminases plasma levels and histopathological tissue damage were determined as markers of hepatocellular injury.</p><p><strong>Results: </strong>Sinusoidal perfusion failure, leukocyte recruitment to the liver, and transaminase activities were sharply increased upon I/R compared to sham-operated mice. Firm adhesion of platelets and concordantly leukocytes to endothelial cells is reduced significantly by a function-blocking anti-CX3CL1 antibody. We demonstrate that inhibition of CX3CL1 signaling attenuates leukocyte adhesion in the postischemic liver but does not significantly ameliorate overall perfusion failure and hepatocellular injury.</p><p><strong>Discussion/conclusion: </strong>Our in vivo data demonstrate a mild attenuating effect of CX3CL1 blockade on platelet and leukocyte, but not CD4+ T cell accumulation and activation in hepatic I/R injury. We report a significant effect of blocking chemokine CX3CL1 on sinusoidal perfusion failure without considerably improving overall hepatocellular injury during early reperfusion.</p>","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":"64 2","pages":"185-192"},"PeriodicalIF":1.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9808741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10055061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left Ventricular Wall Reconstruction with Autologous Vascularized Tunica Muscularis of Stomach in a Porcine Pilot Model.","authors":"Tobias Schilling,&nbsp;Tanja Meyer,&nbsp;Gudrun Brandes,&nbsp;Dagmar Hartung,&nbsp;Igor Tudorache,&nbsp;Ingo Nolte,&nbsp;Frank Wacker,&nbsp;Andres Hilfiker,&nbsp;Klaus Hoeffler,&nbsp;Axel Haverich,&nbsp;Serghei Cebotari","doi":"10.1159/000522478","DOIUrl":"https://doi.org/10.1159/000522478","url":null,"abstract":"Introduction: Surgical replacement of dysfunctional cardiac muscle with regenerative tissue is an important option to combat heart failure. But, current available myocardial prostheses like a Dacron or a pericardium patch neither have a regenerative capacity nor do they actively contribute to the heart’s pump function. This study aimed to show the feasibility of utilizing a vascularized stomach patch for transmural left ventricular wall reconstruction. Methods: A left ventricular transmural myocardial defect was reconstructed by performing transdiaphragmatic autologous transplantation of a vascularized stomach segment in six Lewe minipigs. Three further animals received a conventional Dacron patch as a control treatment. The first 3 animals were followed up for 3 months until planned euthanasia, whereas the observation period for the remaining 3 animals was scheduled 6 months following surgery. Functional assessment of the grafts was carried out via cardiac magnetic resonance tomography and angiography. Physiological remodeling was evaluated histologically and immunohistochemically after heart explantation. Results: Five out of six test animals and all control animals survived the complex surgery and completed the follow-up without clinical complications. One animal died intraoperatively due to excessive bleeding. No animal experienced rupture of the stomach graft. Functional integration of the heterotopically transplanted stomach into the surrounding myocardium was observed. Angiography showed development of connections between the gastric graft vasculature and the coronary system of the host cardiac tissue. Conclusions: The clinical results and the observed physiological integration of gastric grafts into the cardiac structure demonstrate the feasibility of vascularized stomach tissue as myocardial prosthesis. The physiological remodeling indicates a regenerative potential of the graft. Above all, the connection of the gastric vessels with the coronary system constitutes a rationale for the use of vascularized and, therefore, viable stomach tissue for versatile tissue engineering applications.","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":"64 2","pages":"177-184"},"PeriodicalIF":1.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9808675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9672267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine Green Is a Safe and Effective Alternative to Radioisotope in Breast Cancer Sentinel Lymph Node Biopsy regardless of Patient Body Mass Index.","authors":"Samantha Ng, Vassilis Pitsinis, Emad H Elseedawy, Douglas Brown, Alessio Vinci, Benjamin A Jones, E Jane Macaskill","doi":"10.1159/000528155","DOIUrl":"10.1159/000528155","url":null,"abstract":"<p><strong>Introduction: </strong>A recent meta-analysis [Lancet Oncol. 2010;11:908-909] has confirmed high sensitivity of indocyanine green (ICG) fluorescence mapping for sentinel node detection in early breast cancer. Concerns have previously been raised regarding the efficacy in patients with high body mass index (BMI).</p><p><strong>Materials and methods: </strong>All consecutive patients undergoing sentinel lymph node biopsies (SLNBs) for early breast cancer in NHS Tayside were included in a prospective audit of surgical and pathology findings. All patients included in the study received dual injection of patent blue dye and ICG. Approval was obtained from the local Caldicott guardian for collection and use of personal data.</p><p><strong>Results: </strong>Of 239 cases, all were female patients of mean age 62 years (range 27-93). In 4.2% (10/239) of cases, neither blue dye nor ICG was present in the axilla. Of the remaining 229 SLNB cases in this series, surgeons documented retrieval of 451 nodes, with a mean surgical nodal count per case of 1.97 (range 1-5) and pathological nodal count of 2.15 (range 0-7). Eighty three cases were performed in patients with BMI 30-39.9 and 21 cases with BMI ≥40, with nodal detection rates of 96.4% (80/83) and 95.2% (20/21), respectively, in these groups of patients. Twenty percent (48/229) of cases had nodal metastases on histopathology.</p><p><strong>Conclusions: </strong>This is a large single-center study which demonstrates the safety and accuracy of the combined ICG and blue dye technique for SLNB in breast cancer. This is represented by nodal detection rates and node positivity rates which are comparable to previous multicenter studies of standard SLNB regardless of BMI.</p>","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":"64 2","pages":"230-236"},"PeriodicalIF":1.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9684997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the Surgical Apgar Score in Laboratory Animal Science: A Showcase Pilot Study in a Porcine Model and a Review of the Literature.","authors":"Lisa Ernst,&nbsp;Anna Maria Kümmecke,&nbsp;Leonie Zieglowski,&nbsp;Wenjia Liu,&nbsp;Mareike Schulz,&nbsp;Zoltan Czigany,&nbsp;René H Tolba","doi":"10.1159/000520423","DOIUrl":"https://doi.org/10.1159/000520423","url":null,"abstract":"<p><strong>Introduction: </strong>In an attempt to further improve surgical outcomes, a variety of outcome prediction and risk-assessment tools have been developed for the clinical setting. Risk scores such as the surgical Apgar score (SAS) hold promise to facilitate the objective assessment of perioperative risk related to comorbidities of the patients or the individual characteristics of the surgical procedure itself. Despite the large number of scoring models in clinical surgery, only very few of these models have ever been utilized in the setting of laboratory animal science. The SAS has been validated in various clinical surgical procedures and shown to be strongly associated with postoperative morbidity. In the present study, we aimed to review the clinical evidence supporting the use of the SAS system and performed a showcase pilot trial in a large animal model as the first implementation of a porcine-adapted SAS (pSAS) in an in vivo laboratory animal science setting.</p><p><strong>Methods: </strong>A literature review was performed in the PubMed and Embase databases. Study characteristics and results using the SAS were reported. For the in vivo study, 21 female German landrace pigs have been used either to study bleeding analogy (n = 9) or to apply pSAS after abdominal surgery in a kidney transplant model (n = 12). The SAS was calculated using 3 criteria: (1) estimated blood loss during surgery; (2) lowest mean arterial blood pressure; and (3) lowest heart rate.</p><p><strong>Results: </strong>The SAS has been verified to be an effective tool in numerous clinical studies of abdominal surgery, regardless of specialization confirming independence on the type of surgical field or the choice of surgery. Thresholds for blood loss assessment were species specifically adjusted to >700 mL = score 0; 700-400 mL = score 1; 400-55 mL score 2; and <55 mL = score 3 resulting in a species-specific pSAS for a more precise classification.</p><p><strong>Conclusion: </strong>Our literature review demonstrates the feasibility and excellent performance of the SAS in various clinical settings. Within this pilot study, we could demonstrate the usefulness of the modified SAS (pSAS) in a porcine kidney transplantation model. The SAS has a potential to facilitate early veterinary intervention and drive the perioperative care in large animal models exemplified in a case study using pigs. Further larger studies are warranted to validate our findings.</p>","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":"64 1","pages":"54-64"},"PeriodicalIF":1.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9226051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vagal Nerve Therapy in the Management of Obesity: A Systematic Review and Meta-Analysis.","authors":"Michael G Fadel, Matyas Fehervari, Bibek Das, Payam Soleimani-Nouri, Hutan Ashrafian","doi":"10.1159/000533358","DOIUrl":"10.1159/000533358","url":null,"abstract":"<p><strong>Introduction: </strong>The vagus nerve has an important role in satiety, metabolism, and autonomic control in upper gastrointestinal function. However, the role and effects of vagal nerve therapy on weight loss remain controversial. This systematic review and meta-analysis assessed the effects of vagal nerve therapy on weight loss, body mass index (BMI), and obesity-related conditions.</p><p><strong>Methods: </strong>MEDLINE, EMBASE, and CINAHL databases were searched for studies up to April 2022 that reported on percentage excess weight loss (%EWL) or BMI at 12 months or remission of obesity-related conditions following vagal nerve therapy from January 2000 to April 2022. Weighted mean difference (WMD) was calculated, meta-analysis was performed using random-effects models, and between-study heterogeneity was assessed.</p><p><strong>Results: </strong>Fifteen studies, of which nine were randomised controlled trials, of 1,447 patients were included. Vagal nerve therapy led to some improvement in %EWL (WMD 17.19%; 95% confidence interval [CI]: 10.94-23.44; p &lt; 0.001) and BMI (WMD -2.24 kg/m2; 95% CI: -4.07 to -0.42; p = 0.016). There was a general improvement found in HbA1c following vagal nerve therapy when compared to no treatment given. No major complications were reported.</p><p><strong>Conclusions: </strong>Vagal nerve therapy can safely result in a mild-to-moderate improvement in weight loss. However, further clinical trials are required to confirm these results and investigate the possibility of the long-term benefit of vagal nerve therapy as a dual therapy combined with standard surgical bariatric interventions.</p>","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":" ","pages":"365-375"},"PeriodicalIF":1.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10387132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Validation of the Comprehensive Complication Index in a Pancreaticoduodenectomy Cohort.","authors":"Zhenghua Cai,&nbsp;Yifei Yang,&nbsp;Yuqing Han,&nbsp;Xu Fu,&nbsp;Liang Mao,&nbsp;Yudong Qiu","doi":"10.1159/000530634","DOIUrl":"https://doi.org/10.1159/000530634","url":null,"abstract":"<p><strong>Introduction: </strong>Although the Clavien-Dindo classification (CDC) is the most widely utilized method for quantifying surgical complications, it fails to properly capture all events. To address this, the comprehensive complication index (CCI) was introduced. The purpose of this study was to compare the CCI and CDC as predictors of postoperative length of stay (PLOS) and total hospitalization costs in patients undergoing pancreaticoduodenectomy (PD).</p><p><strong>Methods: </strong>Data were collected from February 2018 to February 2021. Complications were graded on the CDC scale and the CCI was calculated for each patient. The correlations between CDC and CCI with PLOS and hospitalization costs were compared. Linear analyses were performed to identify factors associated with PLOS and costs.</p><p><strong>Results: </strong>291 patients were enrolled with an average age of 61.2 years. 286 of them developed postoperative complications at CDC grade 1 (17.8%), 2 (59.9%), 3a (13.4%), 3b (4.5%), 4 (2.1%), and 5 (0.6%). Median CCI of the study cohort was 30.8. Spearman's correlation analysis showed the CDC and CCI were significantly correlated with PLOS and hospitalization costs, but the CCI showed a stronger correlation with PLOS (+0.552 day of stay for each additional CCI point; CCI: ρ = 0.663 vs. CDC: ρ = 0.581; p = 0.036). There were no significant differences in the correlations between total hospitalization costs and the CDC or CCI (CCI: ρ = 0.566 vs. CDC: ρ = 0.565; p = 0.78).</p><p><strong>Conclusion: </strong>CCI is an accurate tool for quantifying morbidities after PD and shows a stronger correlation with PLOS compared with the CDC.</p>","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":"64 3","pages":"334-341"},"PeriodicalIF":1.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10529750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Platelet Rich Plasma (PRP) Injection to the Wound Compared to PRP Jel Local Application Compared to Classic Dressing on Diabetic Foot Healing Ulcer","authors":"Hassan Awas Saad, A. Yehia, G. Osman","doi":"10.33425/2689-1093.1048","DOIUrl":"https://doi.org/10.33425/2689-1093.1048","url":null,"abstract":"Background: The goal of our work-study was to detect the net result and potency of of PRP local jnj. Dressings compared to PRP in jel to the wound for DFU healing compared to a control therapy of traditional classic dressing (PRP) also to decrease the recurrence (DFUs). Diabetic foot is a more famous and face any surgeon in his clinic or hospital. It has a new promise therapy of diabetic foot ulceration (DFU), with cellular and tissue regeneration, because of several methods in wound care management. All hope to attain good healing and hope to decrease recurrent rate. Patients and Methods: Forty-five patients with DFU were matched and grouped for (PRP) local injection dressings (n = 15), PRP jel to wound edges (n = 15), or classic dressing (n = 15) from August 2019 to March 2021. There were additional complications and ulcer recurrences were detected Ulcer or raw area healing and reduction were the primary objectives at 1; 3, 6, and 12 months. The study comprised 36 (80.0%) males and 9 (20.0%) females between the ages of 30 and 65 who had DFU for 1 to 10 years. Results: Local PRP injections improved healing 12/15 (80%) greater than local PRP jel dressings 10/15 (66.7%) and classic dressings 7/15(46.7%). However, PRP wound injection increase the healing of diabetic ulcers raw area more than PRP local jel or traditional classic dressing the healing period following local PRP injection was much shorter. At all follow-up visits, the in all the groups had similar rates of recurrence and complications. All of them had similar recurrence and variant safety. Conclusions: PRP injection is a more potent technique for treating DFU than local PRP jel administration and classic wound dressings, with slight the same recurrence. Less Amputation rates, infection rates, and discharges are all reduced with PRP injection than PRP jel than classic treatment.","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":"99 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78388325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cicatricial Parietal Endometriosis: A Case Report of an Unusual Location","authors":"Prosper Nsengiyumva, Noureddine Njoumi, Aziz Fadili, M. El Fahssi, A. Elhjouji, A. Zentar, A. Ait Ali","doi":"10.33425/2689-1093.1045","DOIUrl":"https://doi.org/10.33425/2689-1093.1045","url":null,"abstract":"Endometriosis of the abdominal wall is a rare pathology occurring after gynecological or obstetrical surgery. We report the case of a patient presenting with menstrual pain localised at the point of a caesarean scar. The clinical examination found a nodule located at the level of the right iliac fossa. The rest of the examination was normal. Computer tomography (CT) scan showed a nodular focus that has a long axis of 2.38 cm which is hypo dense, hence the decision to excise the lesion. After excision, the anatomo-pathological studies confirmed the diagnosis of endometriosis. An 18 months post-operative follow-up was done and there was no complication found, no recurrence of the mass or pain at the site of excision.","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":"3 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89628101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Intermittent Dysphagia is not a Contraindication for Total Nissen Fundoplication","authors":"T. Franzen","doi":"10.33425/2689-1093.1044","DOIUrl":"https://doi.org/10.33425/2689-1093.1044","url":null,"abstract":"Aim: To study the effect of total Nissen fundoplication on severe intermittent esophageal dysphagia according to a hiatal hernia. Methods: Twenty-three consecutive patients (12 men, 11 women, median age 43 yrs) with severe intermittent dysphagia and with hiatal hernia verified by endoscopy were included in the study. They were investigated with esophageal high-resolution manometry (HRM)-, and 24-hr pH- monitoring prior to hiatal hernia repair and at follow-up 6 months after surgery. On both test occasions, the patients were asked to fill in a questionnaire comprising 17 questions on esophageal and chest symptoms (severity grades 0-3). Results: A hiatal hernia was recorded via HRM in all 23 patients prior to surgery and in no one at follow-up. Prior to surgery, all patients had either severe no stenotic dysphagia or frequent retention symptoms in the chest while eating. These two mechanical problems were relieved by surgery (p< 0.0001). Motility disturbances in the distal esophagus were recorded in 35 % of patients prior to surgery, but in no one at follow-up. The median total reflux time prior to surgery was 2.2 % (range 0.2 – 36.5 %) and at follow-up 0 % (0 – 0.3 %). Five patients had no pathological gastro-esophageal reflux prior to surgery. Conclusion: Severe intermittent esophageal dysphagia in hiatal hernia patients can be successfully treated with total Nissen fundoplication, and this should be a strong indication for hiatal hernia surgery even in the absence of pathological gastro-esophageal reflux.","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":"97 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80238590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pheochromocytoma and Extraadrenal Paraganglioma: Case Report and Review of the Laparoscopic Approach","authors":"Saul Eduardo Torres Arano, Bryan Armando Morales Eslava, Manuel Guadalupe Torres Gonzalez, Carolina Flores Castro, Federico Lopez Rosales","doi":"10.33425/2689-1093.1046","DOIUrl":"https://doi.org/10.33425/2689-1093.1046","url":null,"abstract":"The reported percentage of catecholamine-producing tumors is around 80-85% in pheochromocytomas and 15- 20% in paragangliomas. The case of a 34-year-old female patient with a clinical, imaging and histopathological diagnosis of pheochromocytoma with paraganglioma with successful laparoscopic surgical resolution with a retroperitoneal approach is described. The cardinal symptom is uncontrolled hypertension despite medical management with multiple antihypertensives. The initial diagnostic approach is with the measurement of metanephrines in plasma and urine, if this is not conclusive, the clonidine test can be performed. With a positive laboratory result, an imaging study should be performed for localization and finally surgical resolution with a preference for the laparoscopic approach, with less risk of post-surgical complications.","PeriodicalId":12222,"journal":{"name":"European Surgical Research","volume":"28 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76070928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}