Acta Chirurgica Belgica最新文献

{"title":"How to address post-Roux-en-Y gastric bypass late dumping in a patient with a history of Nissen fundoplication converted to bypass for obesity.","authors":"Jean-Philippe MmK Magema, Jacques Himpens","doi":"10.1080/00015458.2025.2468063","DOIUrl":"10.1080/00015458.2025.2468063","url":null,"abstract":"<p><strong>Introduction: </strong>Reversal of Roux-en-Y gastric bypass (RYGB) may be indicated for possible side effects such as malnutrition, intolerance, dumping syndrome, or late dumping. Reversal can however induce significant gastro-esophageal reflux disease (GERD).</p><p><strong>Method: </strong>We report the case of a 55 years old Caucasian woman, who had undergone conversion of Nissen fundoplication performed for GERD (Grade B) into RYGB because of recurrent reflux, though Grade A esophagitis and increasing obesity (37.5 kg/m² BMI). She developed invalidating symptoms of late dumping syndrome and severe diarrhea. Pre- and postoperative evaluation an eso-gastroscopy with esophagitis grade evaluation. Treatment consisted of physiologic reversal of the RYGB, by reimplantation of the alimentary limb into the remnant stomach.</p><p><strong>Result: </strong>Pre-reversal endoscopy showed Grade A esophagitis. Oral glucose test demonstrated severe hypoglycemia persisting till 120 min post-ingestion and clinical symptoms of hypoglycemia (Whipple triad) (40 to 53 mg/dl). Three months after reversal the diagnostic tests had significantly improved, both in terms of glucose metabolism and GERD symptoms. At 22 months after surgery, the patient still did not suffer from diarrhea anymore, her glycemic profile was stable under antidiabetic medications and her BMI raised to 29 kg/m².</p><p><strong>Discussion and conclusion: </strong>Reversal of Roux-en-Y gastric bypass by incorporation of the alimentary limb between the gastric pouch and the gastric remnant seems to successfully address the dual issue of post-RYGB late dumping and preventing GERD, the different mechanisms involved will be explained latter in this paper.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"170-174"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497813","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":"Incidental finding of giant dedifferentiated liposarcoma of the spermatic cord: case report and review of the literature.","authors":"Andreas Bouckaert, Bruno Bamelis, Lieven Dedrye, Stefan Sohier, Anneleen Verbrugghe, Johan Fierens","doi":"10.1080/00015458.2025.2481696","DOIUrl":"10.1080/00015458.2025.2481696","url":null,"abstract":"<p><strong>Introduction: </strong>Giant dedifferentiated liposarcomas of the spermatic cord are a rare and aggressive entity. Both large size and dedifferentiated liposarcoma histology implicate a poorer prognosis with a high risk of recurrence and metastasis.</p><p><strong>Methods: </strong>This is a retrospective case report. We describe a 58-year-old patient who presented with a hemodynamic collapse, caused by a high gastro-intestinal bleeding. A giant inguinoscrotal mass challenged the diagnostic path.</p><p><strong>Results: </strong>A combined abdominal and scrotal approach was used to remove the giant mass (26 × 15 × 11 cm, 1.617 kg) en bloc with the right testicle and spermatic cord. Pathological examination showed a giant dedifferentiated liposarcoma (FNCLCC grade 2), with a microscopically complete resection. Follow-up at 24 months showed no locoregional recurrence or distant metastasis.</p><p><strong>Conclusion: </strong>Radical surgery remains the cornerstone of treatment for retroperitoneal liposarcoma. Microscopically complete resection is an important positive prognostic indicator for risk of recurrence. Rigorous follow up is necessary, considering the high risk for recurrence. This patient illustrates the challenge of not allowing the giant inguinoscrotal mass to draw away all attention from a life-threatening high gastro-intestinal bleeding.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"164-169"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794337","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":"Common trunk between V^1 + 2 and V³ of the left superior pulmonary vein.","authors":"Dario Amore, Dino Casazza, Pasquale Imitazione, Umberto Caterino, Lucio Cagini","doi":"10.1080/00015458.2025.2502777","DOIUrl":"10.1080/00015458.2025.2502777","url":null,"abstract":"","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"175-176"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957926","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":"Teaching humanitarian surgery: filling the gap between NGO needs and subspecialized surgery through a novel inter-university certificate.","authors":"Maximilien Thoma, Lynette Dominguez, Martial Ledecq, Jean-Paul Goolaerts, Réginald Moreels, Innocent Nyaruhirira, Jean-François Brichant, Thierry Roumeguere, Raymond Reding","doi":"10.1080/00015458.2020.1846943","DOIUrl":"10.1080/00015458.2020.1846943","url":null,"abstract":"<p><strong>Background: </strong>Access to surgical care is a global health burden. A broad spectrum of surgical competences is required in the humanitarian context whereas current occidental surgical training is oriented towards subspecialties. We proposed to design a course addressing the specificities of surgery in the humanitarian setting and austere environment.</p><p><strong>Method: </strong>The novelty of the course lies in the implication of academic medical doctors alongside surgeons working for humanitarian non-governmental organizations (NGO). The medical component of the National Defense participated regarding particular topics of war surgery. The course is aimed at trained surgeons and senior residents interested in participating in humanitarian missions.</p><p><strong>Results: </strong>The program includes theoretical teaching on surgical knowledge and skills applied to the austere context. The course also covers non-medical aspects of humanitarian action such as international humanitarian law, logistics, disaster management and psychological support. It comprises a large-scale mass casualty exercise and a practical skills lab on surgical techniques, ultrasonography and resuscitation. Attendance to the four teaching modules, ATLS certification and succeeding final examinations provide an interuniversity certificate. Thirty participants originating from 11 different countries joined the course. Various surgical backgrounds, training levels as well as humanitarian experience were represented. Feedback from the participants was solicited after each teaching module and remarks were applied to the following session. Overall participant evaluations of the first-course session are presented.</p><p><strong>Conclusion: </strong>Teaching humanitarian surgery joining academic and field actors seem to allow filling the gap between high-income country surgical practice and the needs of the humanitarian context.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"125-131"},"PeriodicalIF":0.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38726741","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":"Surgical management of pseudomyxoma peritonei: low-volume center experience.","authors":"Charif Khaled, Lina Safar, Alain Hendlisz, Maria Gomez Galdon, Paulus Kristanto, Michel Moreau, Ana Veron Sanchez, Gabriel Liberale","doi":"10.1080/00015458.2025.2510121","DOIUrl":"10.1080/00015458.2025.2510121","url":null,"abstract":"<p><strong>Introduction: </strong>Pseudomyxoma peritonei (PMP) is a rare disease characterized by diffuse peritoneal invasion of multifocal mucinous deposits. Gold standard treatment involves cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). We aimed to compare the outcomes of operated PMP patients in a low-volume center, with those of high-volume centers and using other regimens.</p><p><strong>Materials and methods: </strong>Retrospective analysis was conducted for PMP patients treated by CRS + HIPEC (using the Elias high-dose Oxaliplatin HIPEC regimen) over a 15-year period (January 2007 - December 2021) at the Jules Bordet Institute - H.U.B.</p><p><strong>Results: </strong>32 patients were included. Pathology results were: 21.9% acellular mucin, 34.4% low-grade, and 43.7% high-grade. The median peritoneal cancer index was 24 (range 3-36). The median follow-up was 58 months. The rate of major complications (Clavien-Dindo III/IV) was 41% and postoperative mortality was 3%. Mean disease-free survival (DFS) was estimated at 40 +/- 4 months (standard deviation (SD)) while overall survival (OS) was 122 +/- 9 months (SD). DFS reached a plateau of 44.5% at 5 and 10 years and OS was 92.3% and 76.2% respectively. Statistical analysis showed low-grade PMP to be predictive of better DFS and OS (<i>p</i> = 0.0111 and <i>p</i> = 0.0293 respectively). We also found that female gender was predictive of better DFS (<i>p</i> = 0.0262).</p><p><strong>Conclusion: </strong>Our postoperative morbidity and mortality rates, DFS, and OS were similar to those reported in the literature for high-volume PMP centers. Our theory is that surgical proficiency can be more attributed to the surgeon's CRS experience, regardless of the nature of the disease.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"1-7"},"PeriodicalIF":0.6,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109197","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":"Adrenal cortical carcinoma - a case series and literature review of aggressive adrenal incidentalomas.","authors":"Liesbeth Verlinde, Sam Kinet, Klaas Van Den Heede, Nele Brusselaers, Sam Van Slycke","doi":"10.1080/00015458.2025.2506935","DOIUrl":"10.1080/00015458.2025.2506935","url":null,"abstract":"<p><strong>Objective: </strong>Adrenal cortical carcinoma (ACC) is a rare and aggressive endocrine malignancy. Clinical symptoms are mainly related to excess hormone secretion. Hypercortisolism and virilisation are among the most common presentations.</p><p><strong>Methods: </strong>We report a case series of five patients with ACC, three of which presented as adrenal incidentalomas. Additionally, a literature review on current diagnosis and management of ACC was performed.</p><p><strong>Results: </strong>ACCs are often incidentally detected because of the liberal use of medical imaging. Management of ACC remains challenging, and the poor prognosis makes early diagnosis of crucial importance to increase chances of a better outcome. Biochemical evaluation should be performed to diagnose hormonally active tumours.</p><p><strong>Conclusion: </strong>Surgery is the main and only potentially curative treatment option. Adjuvant treatment with mitotane may improve survival and is indicated for patients with a perceived high risk of recurrence. Aggressive cytotoxic therapy should be given to patients with an unfavourable prognosis.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"1-9"},"PeriodicalIF":0.6,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075318","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":"Plain versus drug-eluting balloon angioplasty in the treatment of non-thrombotic hemodialysis arteriovenous fistula stenosis: results from a single center comparative retrospective analysis.","authors":"Merve Horoz, Murat Yoğurtçu, Anıl Hüvez, Ömür Ballı, Serkan Gür","doi":"10.1080/00015458.2025.2503647","DOIUrl":"https://doi.org/10.1080/00015458.2025.2503647","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the mid-term primary and assisted-primary patency results of plain balloon angioplasty (PBA) versus drug-eluting balloon angioplasty (DEB) with non-thrombotic arteriovenous fistula (AVF) stenosis in hemodialysis (HD) patients.</p><p><strong>Subject and methods: </strong>A total of 128 consecutive HD patients, who underwent endovascular treatment with DEB or PBA between October 2015 and December 2021, were investigated in this retrospective study. Color Doppler examination was performed for follow-up after 1, 3, 6, 12, 18, 24, and 36 months. Survival curves for primary and assisted primary vein patencies of the PTA and DEB group were generated with Kaplan-Meier survival analysis and were compared with the log-rank test.</p><p><strong>Results: </strong>78 patients (60.9%) underwent PBA (45 men, 33 women; mean age: 64.2 ± 13.9, range: 29-82 years) and 50 (39%) patients underwent DEB (36 men, 14 women; mean age: 65.6 ± 12.8, range: 28-87 years). The estimated primary patency rates at 6, 12,18, 24, and 36 months for the DEB group (95.5%, 92.8%, 88.6%, 77.1% and 54.0%, respectively) were significantly higher than those in the PBA group (84.5%, 76.9%, 73.9%, 66.4% and 59.0%, respectively) (<i>p</i> = .048). Assisted primary patency rates at 6, 12, 18, 24, and 36 months were higher in the DEB group (97.9%, 95.4%, 90.2%, 87.3% and 75.5%, respectively) than PBA group (94.7%, 86.9%, 85.0%, 78.0%, and 66.9%, respectively) but they were not statistically significant (<i>p</i> = .187).</p><p><strong>Conclusion: </strong>Our study confirms DEB is a safe and effective treatment of dysfunctional AVF. We demonstrate higher primary patency rates in DEB than PBA at 6, 12, 18, 24 and 36 months. However, no statistically significant were detected between the two groups in mid-term follow-up.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"1-7"},"PeriodicalIF":0.6,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957166","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":"Historical perspectives on the surgical treatment of hernias in Greece: from 18th century's attempts to late 19th century's innovations in hernia surgery.","authors":"Laios Konstantinos, Pavlos Lytsikas-Sarlis, Lazaros Vladimiros, Dimitrios Filippou, Stylianos Kykalos, Irina Noskova, Dimitrios Zisiadis, Tsoucalas Gregory, Dimitrios Schizas","doi":"10.1080/00015458.2025.2499843","DOIUrl":"https://doi.org/10.1080/00015458.2025.2499843","url":null,"abstract":"<p><strong>Purpose: </strong>To understand the possibilities and the limitations of the modern Greek surgeons during nineteenth century on hernia surgery.</p><p><strong>Methods: </strong>Research on the authentic medical writings of the Greek physicians during nineteenth century. The majority of them is brought to light for the first time.</p><p><strong>Results: </strong>The Greek surgeons of the nineteenth century tried a lot to be updated according to the achievements of the European surgeons regarding the surgery of hernias. Many prominent Greek surgeons contributed to the formation of a scientific method in order this to be taught to the medical students and to the other Greek physicians of the time.</p><p><strong>Conclusion: </strong>In Greece, it was Spyridon Kontoleon who adopted Lister's method to prevent infections, while his team of physicians contributed further in hernia surgery. The earliest documented with a figure hernia case was that of Pavlos Ioannou in 1882. Theodoros Aretaios recorded his cases, demonstrating an interest in hydroceles. Many of his cases may be found in his archive in the National Library of Greece. Procedures' description and vivid depictions paved the way of hernia surgery's evolution in the newly formed Greek state.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"1-9"},"PeriodicalIF":0.6,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959248","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":"Surgical training; destination unknown? A survey on surgical employment in Flanders.","authors":"Niels Komen, Marian Vanhoeij, Paul De Leyn, Frederik Berrevoet, Piet Pattyn, Guy Hubens","doi":"10.1080/00015458.2024.2391176","DOIUrl":"10.1080/00015458.2024.2391176","url":null,"abstract":"<p><strong>Background: </strong>A surgical fellowship allows both additional training as well as maintenance of surgical skills while searching for a steady job. As the presence of fellows usually does not result in a measurably higher productivity, fellowships may be considered a form of disguised unemployment. The aim of this study is to evaluate the career flow of a surgical trainee to a staff position and to determine the number of surgeons working on temporary basis within the general surgery workforce in Flanders.</p><p><strong>Methods: </strong>All surgeons graduated in Flanders between 2000 and 2022 were invited to fill out a web-based survey concerning their current and past employment. Reminders were sent out after 2 and 4 weeks. Statistical analysis was performed with SPSS version 27.0 (IBM Inc., Chicago, IL).</p><p><strong>Results: </strong>Response rate was 64% (292/457) with 76% of respondents currently working as surgeons, 14% (38) as fellows and 10% working outside the surgical domain. Eighty-two percent of current fellows graduated in 2019 or later. Thirty-one percent of surgeons graduated in 2019 are still working as fellows. For surgeons graduated in 2020, 2021 and 2022, this is 45%, 80% and 90%, respectively. Compared to staff surgeons, the number of additional training years (2.8 ± 1.0 vs. 2.2 ± 1.3; <i>p</i> = .009) and the number of applications (6.6 ± 5 vs. 3.3 ± 3; <i>p</i> < .001) are significantly higher for current fellows.</p><p><strong>Conclusion: </strong>This study shows that disguised unemployment is present in the general surgical community in Flanders. The status of 'fellow' should be incorporated in calculations concerning future needs of the surgical workforce in order to prevent open unemployment.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"1-6"},"PeriodicalIF":0.6,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905506","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":"An early report of using protecting gloves by Ḥakim Mohammad, a Persian surgeon (16th century CE).","authors":"Narges Tajik, Zahra Ghahremani, Sobhan Ghezloo, Shahrzad Irannejad, Arman Zargaran","doi":"10.1080/00015458.2025.2489802","DOIUrl":"10.1080/00015458.2025.2489802","url":null,"abstract":"<p><strong>Background: </strong>Although using gloves in surgery dates back to the nineteenth century in modern medicine, it seems that the earliest evidence can be found in the Middle Ages.</p><p><strong>Methods: </strong>It is a library research-based study on the book of <i>Ḏaḫīre-ye Kāmele</i>, written by Ḥakim Mohammad (Ḥakīm Muhammad), a Persian surgeon in the sixteenth century.</p><p><strong>Results: </strong>Ḥakim Mohammad advises the surgeons to use a sheath made of sheep testicle skin for their fingers when examining a wound and putting ointment and bandage on it to protect oneself from diseases that are transmitted through the skin and blood, such as people with wounds whose wounds are caused by smallpox, anthrax, leprosy and infectious wounds.</p><p><strong>Conclusion: </strong>The words of Ḥakim Mohammad suggest a preliminary concept of using surgical gloves to prevent transmitted diseases, dating back to sixteenth century, 3 centuries before its use in modern era.</p>","PeriodicalId":6935,"journal":{"name":"Acta Chirurgica Belgica","volume":" ","pages":"1-4"},"PeriodicalIF":0.6,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143771001","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}