Clinics of surgery最新文献

{"title":"Etiology of Pilonidal Sinus - The Bottom Line","authors":"Huurman Ea, De Raaff Cal, Smeenk Rm, Toorenvliet Br","doi":"10.47829/cos.2022.7101","DOIUrl":"https://doi.org/10.47829/cos.2022.7101","url":null,"abstract":"Pilonidal sinus disease (PSD) is common among young adults and occurs more often in men than in women (3:1). Pilonidal derives from pilus (“hair”) and nidus (“nest”) and literally means nest of hair. In practice, PSD is mostly defined as the presence of one or more pits or sinus cavities in the sacrococcygeal area that often contain hair and are prone to infection and abscess formation. The etiology of PSD has been discussed for more than two centuries. Our interest in the etiology of PSD was sparked after two patients visited our outpatient clinic with surprising findings in their pilonidal cavities. These findings motivated us to review the literature to better understand the etiology of this disease. Ten articles contained original research on the etiology of PSD in the IGF and were finally included for this review.","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"194 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76031069","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":"Clinical Review of Weight Loss Surgery, Procedures, Complications and Post Procedure Complications Management","authors":"M. B, Mukhtar M, Naqvi S","doi":"10.47829/cos.2022.8504","DOIUrl":"https://doi.org/10.47829/cos.2022.8504","url":null,"abstract":"Introduction: Obesity is worldwide epidemic associated with serious complications both physical and psychological.Weight loss can be achieved with either medications or surgery, however the non-surgical options lacks durability more than two years. The weight loss surgical approaches classifies as: restrictive (adjustable gastric banding, vertical band gastroplasty), restrictive/resective (sleeve gastrectomy), restrictive/malabsorptive (Roux-en-Y gastric bypass, biliopancreatic diversion with duodenal switch) and purely malabsorptive (duodenal switch) options. Aim: Clinical review of different weight loss surgeries, mechanism of achieving weight loss, and complications of each procedure. Management of possible complications for each procedure. Results: [I] Gastric bypass (open and laparoscopic): the most commonly performed operation for long-term weight control in United States. Provides longstanding weight loss, better control of comorbidities as well as post procedure nutritional sequelae. Complications are (1) anastomotic leak (1–5.6%) and management either relaproscopy if detected early or radiological guided drainage for contained collection (2) anastomotic stricture (3- 11%) which can be managed by endoscopic dilatation or surgery (3) internal hernia require reoperation and closure of the defect. [II] Laparoscopic adjustable gastric band: the commonest weight loss surgery procedure in UK, complications are: (1) Pouch enlargement, (2) band erosion and (3) Band slip. [III] Sleeve gastrectomy: It is restrictive procedure involve neither anastomosis nor malabsortion and it is irreversible. Produce its clinical effect by early satiety from stomach volume loss and low circulating ghrelin levels. Complications (1) gastric leak: From staple line with incidence of 0.7-5%. If detected early (>4days) requires urgent surgical repair, however late presentation (5-10 day) for conservative management (2) bleeding. [IV] Biliopancreatic Diversion with Duodenal Switch (BPD/DS), components of the procedure are: (1) sleeve gastrectomy. (2) Division of duodenum between pylorus and sphincter of oddi. (3) Bypassing proximal small intestine through alimentary limb; distal 250 cm of the small intestine from ICV anastomosed end to end with post pyloric duodenum, while billiopancreatic limb has blind end proximal to sphincter of oddi anastomosed distally ileo-ileal about75 to 100 cm from ICV. Advantages are morbid obese patient can lose more weight and maintain it comparing with other bariatric procedures also it has a better control of comorbidities. Complications are: anastomotic leak, bleeding and nutritional deficiencies. Conclusion: Many surgical procedures have emerged as an acceptable bariatric surgical option for obese patients. Most of the bariatric procedures available nowadays offer beside weight loss, a better control of the obesity related comorbidities as Biliopancreatic Diversion with Duodenal Switch (BPD/DS), while others as adjustable gastric band ha","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80195010","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":"Prospective Study on Clinical Outcomes of Laparoscopic Repair of Vesicovaginal Fistula with V-Loc 90 Suture","authors":"Parthajit Mondal, S. Das, M. Bera","doi":"10.47829/cos.2022.7301","DOIUrl":"https://doi.org/10.47829/cos.2022.7301","url":null,"abstract":"1.1. Objective To study feasibility , efficacy and postoperative outcomes of laparoscopic vesicovaginal repair with barbed, resorbable 3-0 V-Loc 90 sutures. 1.2. Methods Patients presented with vesicovaginal fistula and failed with more than 3 weeks of bladder drainage using a foley catheter are selected for study. The cases where the fistula can be approached via vaginal route adequately without episiotomy or moderate to heavy traction, recurrent cases, complex fistulas , post radiation and malignant fistula are excluded from this study. 1.3. Results In our study from March 2019 to November 2021, total 15 patients were enlisted for laparoscopic VVF repair using V-Loc suture. The main objective of laparoscopic repair of VVF is rapid cessation of urinary leakage with early return of normal and complete urinary and genital function. The most common cause of VVF in our studies was hysterectomy 12 (80%), caesarean section 3 cases (20%) . In our study in all cases laparoscopic transperitoneal transvesical mini-O’ Conor approach with an interposition of omental graft or appendices epiploicae were adopted. In our study all fistulas were supratrigonal with average size of 1.8 cm (range 0.8 to 3.4 cm). Mean age of patients undergoing VVF repair was 39.9 years (range 26 to 48years) . Estimated blood loss was 63 ml (range 30 ml to 160 ml) , and mean operative time 130 minutes (range 100 to 190 minutes). There was no serious intraoperative or postoperative complications including: conversion to open procedure, denying operative procedure, vascular, bowel or ureteric injury, blood transfusion, blood clots, pulmonary embolism, cardiac events or strokes. Length of hospital stay was mean 5.2 days (range 3 to 8 days). Patients were instructed to return our outpatient department 14 to 21 days after surgery for cystogram, cystoscopic and vaginal inspection to confirm successful VVF repair and subsequent suprapubic catheter removal. At a mean of 14.7 months (range 6 to 37 months) no recurrence of VVF occurred with success rate is 100% (15 out of 15 patients). 1.4. Conclusions In the era of minimally invasive surgery, it is difficult to deny its role in the management of VVF. It can be performed safely and effectively with shorter operative time. It seems to offer patients a shorter hospital stay, less morbidity , quicker convalescence, better cosmesis and equal efficacy. Technically, laparoscopy provides better visualization through magnification, but is more difficult to learn, as is intracorporeal suturing. Use of resorbable continuous barbed sutures (V-Loc) simplify the technique and reduce the time of surgery while avoiding implementation of knots. Successful treatment using a laparoscopic approach in VVF is highly dependent on the surgeon’s experience, tissue conditions around fistulae, tension-free watertight closure, and adequate postoperative urinary drainage","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83368796","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":"Management of Blunt Chest Trauma; Everything you Need to Know - A Review of Literature","authors":"Santosh Parsekar, Samiksha Arsekar, Ella-Marie Filinto-Sequeira, Frazer C S Rodrigues, Yash Jairam Verenkar, A. Amonkar, J. Rodrigues","doi":"10.47829/cos.2021.8501","DOIUrl":"https://doi.org/10.47829/cos.2021.8501","url":null,"abstract":"Trauma is the leading cause of death worldwide of which two thirds of the patients have blunt chest trauma with varying severity from a simple rib fracture to flail chest. In this paper we are reviewing the existing literature and the management of blunt chest trauma, throwing light on the critical aspects such as evaluation and treatment. Recent advances of VATS in blunt chest trauma are de-scribed as well, majority of the BCT cases are managed non-operatively with only a handful of cases needing surgical intervention by thoracic surgeons. Younger patients have better prognosis as compared to geriatric patients with the same injuries. We also throw light on the admission criteria for BCT cases, indications of tube thoracostomy and indications of thoracotomy in BCT cases. This particular paper will throw light on the management of blunt chest trauma and its various therapeutic options in detail so as to understand this clinical entity and its implications.","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"131 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73953153","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":"Papillary Glioneuronal Tumor of Third Ventricle Endoscopically Treated: Case Report and Review of Literature","authors":"Solou M, Papadopoulos Ek, Ydreos I, Savvanis G, Gavra Mm, Boviatsis Ej","doi":"10.47829/cos.2022.71302","DOIUrl":"https://doi.org/10.47829/cos.2022.71302","url":null,"abstract":"Introduction: Papillary Glioneuronal Tumor (PGNT) is a grade I tumor based on the new World Health Organization CNS tumor classification. Its special feature concerns its biphasic histologic pattern of both glial and neuronal elements. Because of the rarity of this entity, literature is mostly based on case reports. Research Question: The objective of this paper is to display our experience treating endoscopically a papillary glioneuronal tumor located into the third ventricle in an adult patient and to highlight the main points of the literature. Material & Methods: A 75-year-old patient with known Parkinson disease presented with episodes of loss of consciousness and gait disorders in our institution. Brain MRI demonstrated enlargement of ventricular system due to an obstruction caused by an intraventricular tumor in the third ventricle. Results: Patient underwent an endoscopic subtotal removal of the tumor. Postoperative brain CT scan revealed minor residual of the tumor and patient was discharged 2 days after surgery in good clinical condition. Histopathological analysis of the tumor samples matched the diagnosis of PGNT. Postoperative follow-up in 1 month demonstrated great neurological improvement. Discussion & Conclusion: Literature reports that total surgical resection is the treatment of choice in almost all cases of PGNT giving the most favorable clinical outcome. Only 4 cases of PGNT located in 3rd ventricle have been recorded and data for endoscopic management found only for one of the cases concerning a pediatric patient. Therefore, we report for first time removal of third ventricle papillary glioneuronal tumor in adult patients via the endoscopic technique.","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"105 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80692428","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 Frozen Elephant Trunk Technique Combined with Beating Heart in Complicated Type B Dissection","authors":"Hui Jiang, Yu Liu, Zhonglu Yang, Yuguang Ge, Yejun Du, Huishan Wang","doi":"10.47829/cos.2022.7201","DOIUrl":"https://doi.org/10.47829/cos.2022.7201","url":null,"abstract":"FET Frozen Elephant Trunk; SMP Selective Myocardial Perfusion; UHS Upper hemisternotomy; CPB Cardiopulmonary Bypass; SACP Selective Antegrade Cerebral Perfusion; USACP Unilateral Selective Antegrade Cerebral Perfusion; CTA CT Angiography; TND Temporary Neurological Dysfunction; PND Permanent Neurological Deficit; HCA Hypothermia Circulatory Arrest; RBC Red Blood Cell; FFP Fresh Frozen Plasma; LVEF Left Ventricular Ejection Fraction; CA Circulatory Arrest; ICU Intensive Care Unit; CNY Chinese Yuan; ALT Alanine Transaminase; Tnt Troponin T; MHCA Moderate Hypothermia Circulatory Arrest","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87667366","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":"Clinical Study of Single Stage Dorsolateral Onlay Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture","authors":"Mondal Pp, D. Sk, Mahapatra Rs, Bera Mk","doi":"10.47829/cos.2022.7102","DOIUrl":"https://doi.org/10.47829/cos.2022.7102","url":null,"abstract":"1.1. Objectives: To evaluate the results of dorsolateral onlay buccal mucosal graft (BMG) urethroplasty in various types of long segment anterior urethral stricture. 1.2. Materials and Methods: This is a prospective study, conducted in the Department of Urology, Medical College, Kolkata and Burdwan Medical College, Burdwan from April 2017 to March 2021. Forty patients with long segment (more than 1.5 cm) anterior urethral stricture who underwent substitution urethroplasty using dorsolateral onlay BMG urethroplasty were evaluated with detailed history, physical examination, ultrasonography of KUB with PVRU, uroflowmetry, retrograde urethrography and voiding cystourethrography, sono-urethrograms and cystoscopy. After treatment with dorsolateral onlay BMG urethroplasty, they were followed-up with uroflowmetry at 3 monthly interval for one year and RGU and/or urethroscopy if indicated. Success was defined as normal voiding pattern without any intervention post-operatively. 1.3. Results: With nineteen of the forty cases (47.5%), lichen sclerosus formed the single most common etiology. Panurethral strictures were more common. Out of total 40 cases, 33 (82.5%) had successful outcome and 7 (17.5%) were failure. 1.4. Conclusion: We conclude that it is a simple, technically feasible, easily adoptable and finally successful procedure","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83541583","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 Establishment of a High Standard Skin Bank in Taiwan as a Burn Care Pioneer","authors":"Huang Hf, Lin Yc, Huang I, M. J., Tai Hc","doi":"10.47829/cos.2022.71201","DOIUrl":"https://doi.org/10.47829/cos.2022.71201","url":null,"abstract":"Introduction: The establishment of skin banks is especially important in providing crucial cadaveric skin for burn treatments. Although the 2015 Formosa Fun Coast Explosion Disaster resulted in tragic casualties, it raised public awareness of the importance of having a well-functioning skin bank and led to the initiation of a skin bank development project, as well as the establishment of the first high standard skin bank in Taiwan. Methods: We standardized the size of our procured skin to avoid broken or disrupted skin graft, fit properly on a Zimmer Dermacarrier® for mesh expansion, and to be convenient for storage. We also integrated gamma radiation with the glycerol stored skin method for our skin preservation which effectively eradicates all contamination. Results: From 2016 to 2020, 453,100 cm2 of skin were procured from 62 donors and stored in the NTUH skin bank; 254,000 cm2 of which were utilized in the treatment of 75 patients. Between 2016 and 2017, 141 microbiological examinations were administered with six were positive. Since the introduction of gamma radiation, no contamination has been observed hereafter in our examinations. Conclusions: We report the success of establishing a high standard and well-functioning skin bank at NTUH that supply sufficient skin allografts in Taiwan. It is the first interhospital supply of charitable skin allografts across Taiwan. Being humanitarian, our skin bank is passing great love forward.","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85959127","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 Hypospadias, Chordee, Orthoplasty and The Prepucial Hood","authors":"Abhinav Singh, Malika Singh, R. B. Singh","doi":"10.47829/cos.2021.61104","DOIUrl":"https://doi.org/10.47829/cos.2021.61104","url":null,"abstract":"1.1. Purpose: Making the surgeons aware of the significance of penile chordee, need of optimal straightening of penile shaft (orthoplasty) and appropriate use of well-developed prepucial hood for re-construction of an ideal neo-urethral plate and a near normal neo-urethra by its tubularization and finally re-enforcement of the neo-urethra by prepucial dartos fascial flap to minimize post-operative morbidities. 1.2. Aims and Objectives: Exact assessment of characteristics of chordee by artificial erection of penis, achieving acceptable orthoplasty before commencing upon final neo-urethroplasty and making maximum use of prepucial hood skin in (i) formation of neo-urethral plate and to have an ideal near normal non-hairy and resistance free neo-urethra and or (ii) designing and harvesting various types of skin and or water proofing flaps because of its axial vascularity. 1.3. Material and Methods: Material related to the penile chordee, orthoplasty and appropriate utilization of prepucial hood was collected from the photographic record of hypospadias patients who attended “Hypospadias and VVFs Clinic” between 2004- 2016. Based upon the characteristics of penile shaft and its chordee, various surgical techniques used for acceptable correction of the chordee (orthoplasty) were circum-coronal degloving of penile shaft up to its root, excision of chordee, Dorsal Tunica Albuginea Plication (DTAP), Double Dorsal Tunica Albuginea Plication (DDTAP), Ventral Tunica Albuginea Plication (VTAP), Inner Prepucial Full Thickness Skin Graft (IPFTSG), outer Prepucial Full Thickness Skin Graft (OPFTSG), Dermal Graft (DG), Tunica Vag inalis Graft (TVG) and Tunica Vaginalis Flap (TVF). Accidental breach in Tunica Albuginea (TA) was identified and repaired in water tight fashion. Special care was taken to prevent injury to Dorsal Neuro-Vascular Bundle (DNVB). Hypospadiacs with Bala- clinicsofsurgery.com 2 nitis Xerotica Obliterans (BXO) were excluded from study. 1.4. Observations: Neo-urethroplasty in an uncorrected chordee is deemed to be associated with subsequent anatomical, functional and aesthetic problems, thereby warranting re-do orthoplasty and neo-urethroplasty including total dismantling of the previous surgical repair. The presence of fully developed prepucial hood proved to be a boon to the surgeon in repairing both the fresh as well as re-do cases of neo-urethroplasty and also in harvesting water-proofing flaps to decrease post-operative morbidities. Presence of Undescended Testis (UDT), Inguinal Hernia (IH) and Ano-Rectal Malformation (ARM) are to be corrected on priority.","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74679330","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":"Adipose Stem Cell-Derived Exosomes Alleviate the Process of Hypertrophic Scar","authors":"Lin Z, H. y","doi":"10.47829/cos.2021.61101","DOIUrl":"https://doi.org/10.47829/cos.2021.61101","url":null,"abstract":"","PeriodicalId":92767,"journal":{"name":"Clinics of surgery","volume":"139 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75052635","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}