Chirurgia最新文献

Background/ Aim: Total pancreatectomy (TP) is an uncommon type of pancreatic resection, even at high-volume centers. The indications of a TP are not fully defined, and the outcomes are controversial. The study aims to assess the frequency of use, indications, and early outcomes of TP in a contemporary consecutive series of 36 patients. Patients and Methods: The data of all consecutive elective TP performed by three experienced pancreatic surgeons between February 1, 2017, and December 31, 2024, were retrospectively extracted from a prospectively maintained electronic database of pancreatic resections. The data of patients requiring TP were analyzed for indications, surgical technique, and early outcomes. Results: The patients were predominantly males (20 patients, 56%) with a median age of 67 years (range 44-76 years). Pancreatic ductal adenocarcinoma was the main indication (24 patients, 67%). The main reasons for a TP were multicentric lesions (14 patients, 39%), distal pancreas hypoplasia/ hypotrophy (8 patients, 22%), highrisk anastomoses (7 patients, 19%), and positive pancreatic margins (6 patients, 17%) following pancreaticoduodenectomy. Splenectomy was performed in 23 patients (64%), while venous and arterial resections were performed in 4 patients (11%) and two patients (6%), respectively. Overall and severe (i.e., grade 3 Dindo) morbidity rates were 83% and 25%, respectively, with a 90-day mortality of 6%. The primary sources of surgical morbidity were clinically relevant delayed gastric emptying (5 patients, 14%) and bile leak (4 patients, 11%). Conclusions: TP has rare and specific indications, including multicentric tumors, distal pancreas hypotrophy, positive pancreatic neck margins, and high-risk anastomosis after pancreaticoduodenectomy. In experienced hands, severe morbidity and mortality rates are acceptable for such a complex surgical procedure.

Introduction: Laparoscopic resection has become the standard surgical technique in treating colorectal cancer. This approach has many advantages over open surgery such as: faster recovery, lower postoperative pain with reduced postoperative pain scores and opioid requirements and shorter hospital-stay. Improving postoperative pain management by performing transversus abdominis plane block enhances some of the benefits of laparoscopic colorecat surgery. The aim of our study was to emphasize the role and the benefits of transversus abdominis plane block after laparoscopic colorectal resection. Material and Methods: This prospective observational cohort study was conducted at the Fundeni Clinical Institute in Bucharest, Romania, and received ethical approval from the institutional Ethics Committee. We included adult patients aged 18 to 85 years, classified as ASA physical status I-III, undergoing elective laparoscopic colorectal surgery. Exclusion criteria comprised contraindications to TAP block, the necessity for additional analgesic interventions, and specific medical conditions. The TAP block was performed under ultrasound guidance, utilizing 0.25% ropivacaine administered bilaterally. Postoperative pain was evaluated through the Visual Analog Scale (VAS) at intervals of 1, 2, 4, 8, 12, and 48 hours. Analgesic consumption was meticulously recorded, focusing on opioids, paracetamol, tramadol, and Neodolpasse. Results: The findings indicated a significant reduction in paracetamol consumption within the TAP block group, evidenced by a p-value of 0.011, which suggests lower analgesic requirements compared to the control group. Furthermore, the median time to the first analgesic request was significantly prolonged in the TAP block group, recorded at 8 hours (IQR: 0.00) versus 5 hours (IQR: 1.00) in the control group, with a p-value of 0.001. These results imply that the TAP block not only enhances analgesia but also extends the interval before additional analgesics are necessary. Conclusions: The TAP block demonstrates substantial efficacy in multimodal analgesia, significantly reducing both opioid and non-opioid analgesic consumption while improving patient comfort and satisfaction. These findings emphasize the TAP block's effectiveness in addressing somatic pain in the abdominal region. Integrating regional anesthesia techniques into standard surgical protocols is essential for optimizing patient outcomes. Future randomized controlled trials are warranted to further validate these findings and elucidate the underlying mechanisms involved.

Introduction: This study aimed to evaluate the resistance of anastomoses to mechanical traction in an ex vivo biomechanical experiment, to determine the most resistant manual suture for restoring digestive tract continuity after various types of gastric resection for cancer. Materials and methods: The tensile strength of different types of anastomoses was compared ex vivo using porcine esophagus, stomach, and small intestine. The test setup included a tensile testing device, which applied a controlled force on the anastomoses until they broke, which was recorded for each type of anastomosis and was expressed in N. Data processing and statistical analysis were performed in the GraphPad Prism program, using a paired T-test and ANOVA test. We considered the p-value 0.05 to be statistically significant. Results: Double-layer gastrojejunal (Roux-en-Y) and end-to-end esophagojejunal anastomosis presented the highest tensile strength. Double-layer anastomoses showed significantly higher tensile strength compared to monoplane ones. The results suggest that the double-layer suture technique offers better mechanical stability, which may reduce the risk of postoperative complications. Conclusions: Biplane anastomoses after gastric resections may reduce postoperative complications and improve patient outcomes.

Introduction: With being introduced just over a century ago, laparoscopic surgery has become more popular than open. Although a steep learning curve is associated, a plethora of simulators, assessments and courses are available to master laparoscopic skills. However, despite a surgeon's expertise, it can be limited by the camera handler. Very little camera navigation training is provided. The aim of this study is to validate a homemade 0 and 30 deg; laparoscope and laparoscopic camera navigation models. Methods: Homemade laparoscope and various camera navigation models were created. 18 participants with no previous camera handling experience or training were recruited. A brief introduction was provided on the study purpose and tasks. They performed 3 tasks on the 0 deg; laparoscope and model (camera navigation, in line orientation and opposite line orientation) and 30 laparoscope and model (camera navigation). Participants were then asked to answer face-content validation questionnaires for both the laparoscopes and models. Results: The cost of the 0 deg; laparoscope came to 25 pounds and the 30 deg; laparoscope was 20 pounds. In the face and content validity questionnaire, the lowest average score of 7.5 was achieved for how realistic it seemed. Of the models designed for camera navigation, model 5 was used with 0 deg; and model 7 was used with 30 deg;. From the questionnaire, the lowest average score of 6.9 was achieved for how realistic the models seemed. For the 0 deg; camera navigation task, the group average of both attempts was 267 seconds. As expected, in line orientation (61 seconds) was completed quicker than opposite line (151 seconds). For 30 deg; camera navigation, the group average time taken was 134 seconds. Conclusion and future recommendations: The homemade laparoscope has proven to be inexpensive and from the exercises carried out by the participants, it is evident the models are effective. The laparoscopic models came to 2760 poubds. Improvements can be made to make them more effective and inexpensive. Subjective assessments should be looked into to see if they can be made objective. It will be interesting to assess participants again after 3-6 months. A follow up study with more participants would be recommended and also a constructive validity with novices, intermediates and experts.

Hysterectomy is the most common non-obstetric surgical procedure performed in women of all ages, representing a point of intersection between surgery and gynecology, with multiple possible approaches. The lack of a clear consensus on standardized selection criteria for benign pathology results in variability and decisions that may not accurately reflect the specific characteristics of each case. This is a narrative systematic review aimed at identifying and organizing the criteria reported in the literature regarding the selection of surgical techniques for hysterectomy, providing an informative foundation for an individualized and practical approach that supports evidence-based, personalized surgical decision-making. We performed a systematic search in the PubMed, Cochrane Library, and Embase databases between January 1, 2015, and June 1, 2025, considering only English-language randomized controlled trials. The search strategy included both controlled and free terms, combined using Boolean operators. We selected the eight most relevant studies, with a high level of confidence following the quality assessment and consistent findings with the specialized literature. The choice of the optimal surgical technique should be individualized, based on a thorough evaluation of each patient and the expertise of the medical team, to achieve the best possible functional outcomes and quality of life after the intervention.

Introduction: Pericystic-digestive anastomosis is a rarely used but valuable surgical option in the management of complicated hepatic hydatid cysts. Materials and Methods: This retrospective observational study included 24 patients operated on between 2010 and 2023 in a general surgery center in Romania. We analyzed intraoperative decision-making, type of anastomosis, and postoperative outcomes. Results: Roux-en-Y jejunostomy was performed in 19 patients, and pericystogastrostomy in 5. All patients had intraoperatively confirmed biliary fistulas 5 mm. There were no deaths or reinterventions. Minor complications included transient febrile syndrome (12.5%), delayed bowel transit (8.3%), and one percutaneously drained subhepatic collection (4.1%). Follow-up imaging showed progressive reduction of residual cavities in all cases. Conclusions: When correctly indicated, pericystic-digestive anastomosis provides safe and effective internal drainage for large, centrally located cysts with biliary fistulas and well-organized pericysts. Based on clinical experience and current literature, we propose a practical decision-making algorithm to guide surgical management in complicated hepatic echinococcosis.

Background: In rectal cancer surgery, maintaining a balance between oncologic control and postoperative quality of life is critical. Sphincter-preserving procedures may offer better functional outcomes, but results vary depending on the technique used. Methods: This retrospective, observational, single-center study included 62 patients with adenocarcinoma of the rectum =5 cm from the anal verge, operated between August 2022 and August 2024. All received standard neoadjuvant therapy. Patients underwent one of three procedures: abdominoperineal resection, standard coloanal anastomosis, or delayed coloanal anastomosis (Turnbull-Cutait). Functional outcomes were assessed using LARS and St Marks scores at 1, 6, and 12 months postoperatively. Satisfaction was evaluated via telephone interviews. Results: Seventeen patients underwent abdominoperineal resection, 10 received standard coloanal anastomosis, and 35 underwent the delayed technique. Standard anastomosis yielded significantly better continence scores than the Turnbull-Cutait group. Patients with abdominoperineal resection had higher rates of pulmonary complications and prolonged inflammation. At one year, 80% of patients reported satisfaction with the procedure. Conclusion: All techniques can provide high satisfaction, but standard coloanal anastomosis appears to offer superior functional outcomes. Surgical decision-making should be individualized and based on thorough informed consent.

Background: Cholelithiasis is a common gastrointestinal condition that significantly burdens healthcare systems worldwide. The primary cause of gallstone production is cholesterol hypersaturation. Age and female sex are considered more potent risk factors than other factors, but recent studies presented strong associations between cholesterol gallstones and obesity. Case report: We present a case of a 49-year-old male patient with acute onset intensive abdominal pain in the right upper quadrant. Physical examination, abdominal ultrasound, and laboratory analyses confirmed the diagnosis of acute cholecystitis. The cholecystectomy was done and was found a thickened gall bladder wall with gangrenous mucosa and over 300 gallstones sizes ranging from 2 mm to 5 mm inside it. Conclusions: Clinical examination of the patient, laboratory analyses, and abdominal ultrasound diagnoses are gold-standard diagnostic tools. The mainstay of treatment of symptomatic and asymptotic gallstone diseases is surgery, cholecystectomy.

Introduction: The objective of this study was to collect and analyze data on patient demographics, lifestyle, abdominal cavity characteristics, and their impact on intra-abdominal pressure before and after minimally invasive treatment of large parietal defects in hernia pathology. Additionally, the study examines the role of the CT scan as a reliable and valid measure of defect and muscle characteristics, which can help establish the indication for performing Transversus Abdominis Release (TAR) and evaluate the outcomes of this procedure along with differences in intra-abdominal pressure (IAP) and plateau pressure (Pplat). Methods: This prospective study involved 20 patients with parietal defects wider than 10 cm, treated over four years at the Central Military Hospital in Bucharest. All procedures were performed using the laparoscopic TAR technique by the same surgical team. Preoperative assessments included CT imaging to measure defect size, volumes, and IAP. Data including defect dimensions, muscle measurements, IAP, and Pplat were systematically recorded in a dedicated database with a follow-up at 6 months with clinical and imaging evaluations. Results: In our cohort of 20 patients, all female, the mean BMI was 26.81+-3.05, and the hernia sac volume (HSV) averaged 159.01+-189.79 cm³. The defect area was 69.53 cm² (+-30.11). IAP decreased from 5 cmH2O (+-1.28) preoperatively to 1.91 cmH2O (+-1.93) postoperatively. The reduction in Pplat was similarly significant. Pressure variations were influenced by the topographic location of the defect, with higher pressures seen in epigastric defects, and by the characteristics of the peritoneo-fascial defects, including number, size, and localization, which affect pressure outcomes. Additionally, dimensions of the anterior-lateral abdominal muscles correlated with pressure changes. These findings highlight the importance of comprehensive preoperative assessment of defect characteristics, muscular anatomy, and defect location for predicting pressure reductions and guiding surgical planning. Conclusions: Higher BMI and large, multiple parietal defects predict increased IAP and Pplat postoperatively. Preoperative volumetric and morphometric parameters, defect localization, and topographic characteristics significantly influence pressure outcomes. The TAR technique effectively manages large defects while minimizing pressure increases, but consideration of morphological factors is crucial for optimal results. Further research is needed to refine patient selection and surgical strategies.