Chirurgia最新文献

Background: This study aims to validate the feasibility of a hub-and-spoke model for pelvic exenteration (PE) surgery while upholding favorable patient outcomes. Methods: A retrospective analysis of patients undergoing PE at our trust October 2017 and December 2023 was conducted. Descriptive statistics and Kaplan-Meier survival analysis were employed. Results: Sixty-seven patients underwent PE during the study period, mainly for locally advanced colorectal cancer (n=61, 91.04%). Minimally invasive surgery was performed in 16 cases (Robotic 3, 4.47% / Laparoscopic 13, 19.40) while the rest of patients 51 had open surgery (75.11%). Median hospital stay was 12 days (range:8-20). While 24 patients (35.82%) developed major complications (CD III-IV) post-surgery, there were no mortalities associated with pelvic exenteration in this study. Of the 67 patients undergoing surgery with curative intent, negative margins (R0 resection) were achieved in 57 patients (85.12%). This is comparable to outcomes reported by the PelvEx collaborative (85.07% versus 79.8%). At a median follow-up of 22 months, 15 patient (22.38%) recurred with 10.44% local recurrence rate. The 2 years overall and disease-free survival were 85.31% and 77.0.36%, respectively. Conclusion: Our study suggests that a nascent PE service, supported by specialist expertise and resources, can achieve good surgical outcomes within a district general hospital.

Background: This study evaluates the predictive value of preoperative inflammatory markers (NLR, PLR, APRI, SII) and liver function tests in determining the risk of fistula development postcolorectal cancer surgery. The objective was to determine the association between elevated marker levels and fistula risk and establish thresholds for preoperative risk stratification. Methods: A retrospective cohort study was conducted at the "Pius Brinzeu" Clinical Emergency Hospital from 2018 to 2023, analyzing data from 219 patients undergoing colorectal cancer surgery. Results: Among the markers studied, the Systemic Inflammation Index (SII) with a cutoff 460.5 showed the highest sensitivity (75.6%) and specificity (71.3%), resulting in an AUC of 0.774 (p=0.001). Albumin levels 2.9 g/dL also significantly predicted fistula occurrence with 77.3% sensitivity and 73.8% specificity (AUC 0.788, p 0.001). Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) presented cutoffs of 3.95 and 191.6 respectively, demonstrating substantial predictive value with AUCs of 0.732 and 0.746 (p 0.001 and p=0.001, respectively). Conclusions: Elevated levels of specific preoperative inflammatory markers and liver function tests are significantly associated with the risk of developing fistulas in patients undergoing colorectal cancer surgery. These findings support the integration of these biomarkers into preoperative evaluations to enhance patient risk stratification and optimize surgical outcomes, providing a valuable tool for clinical decision-making in colorectal surgery settings.

Complicated colon cancer accounts for up to 40% of colon cancer patients. While the management of complicated right colon cancer has some standard recommendations, for complicated left colon cancer single stage or two-stage procedures are subject to controversies.

Aim: To study the types of procedures and postoperative morbidity and mortality for complicated left colon cancer patients admitted to the 1st Surgical Clinic of the County Clinical Emergency Hospital of Craiova during the past 23 years. We aimed to present the evolution of the surgical management in the emergency procedures for complicated left colon.

Material and method: retrospective study of patients with complicated left colon cancer admitted to our clinic between 2001 and 2023. We analyzed the postoperative morbidity and mortality of each type of emergency procedure (single stage or two-stage) and compared them throughout three periods of time. Results: Three groups observed: G1 â?" 2001-2010, (96 patients); G2 â?" 2011-2016, (65 patients); G3 â?" 2017-2023, (77 patients). We registered significant increase in single stage procedures from G1 to G2 (11.2% vs. 33.8%). In G3, single stage procedure rate decreased significantly (20.8% vs. 33.8%). Postoperative morbidity and mortality was significantly lower in G2 compared to G1 in both single stage and two-stage procedures. G3 compared to G2 registered significant decrease for single stage procedures but similar for two-stage procedures.

Conclusion: For left colon emergencies, two-stage procedures seem safer, as resections with primary anastomosis, even with selected cases and experienced surgeons, still associate higher postoperative morbidity and mortality.

Background: Cholecystectomy has been a subject of debate regarding its timing and utility in cases of mild and moderately severe acute pancreatitis (AP). We aimed to critically evaluate the role of early cholecystectomy in the management of mild and moderate AP, considering patient's characteristics, associated procedures, and overall impact on patient outcomes. Methods: The study compared the outcomes between patients admitted in a tertiary care surgical center undergoing early ( 96h) versus delayed ( 96h) laparoscopic cholecystectomy (LC) for mild and moderately severe acute gallstone pancreatitis between January 2019 and December 2022. Results: The study included 54 cases [mean (standard deviation) age, 59.4 (16.5) years; 31 (57.4%) years females]. All patients underwent LC, with 29 cases undergoing a two-phase therapeutic regimen for common bile duct (CBD) lithiasis, consisting of endoscopic retrograde cholangiopancreatography followed by sequential LC. The early cholecystectomy group (EC) comprised 17 patients (31.5%), while the delayed cholecystectomy group (DC) included 37 patients (68.5%). EC was significantly correlated with lower length of stay (p-value 0.0001) and significantly lower rate of ERCP usage during perioperative period. Conclusions: EC in the first 4 days after admission provides significant benefits such as prevention of recurrent pancreatitis, reduction in complications, and decreased length of stay for patients with mild and moderately severe AP.

Background: multiple studies showed important benefices arising from splenic preservation in patients with digestive cancer in general and gastric cancer in particular. The minimally invasive approach remains controversial in locally advanced gastric cancer cases whilst the open approach still has an important role. This paper's aim is to describe and present the feasibility of an open surgical technique that allows removing stations 10 together with 11p and 11d with spleen and splenic vessels preservation in pacients operated upon by open surgery. Material and Methods: We present an open "Ex-situ" spleen and pancreas preserving surgical technique that removes the anterior and posterior ganglia from the splenic hilum, the splenic vessels and the distal pancreas in locally advanced gastric cancer cases of the upper two thirds of the stomach. Forty-three consecutive patients since 2003 were operated upon by the author in multiple centers. during upper two thirds gastric cancer resections requiring no. 10 lymphadenectomy. Results: no splenectomy was needed . All the spleens were viable at postoperative Doppler echography and CT scans. No spleen migrated nor caused mechanical complications. No clinically significant pancreatic leaks were noticed. Two patients died during hospital stay, one of miocardial infarction and one of massive stroke. Pertinent follow up data and survival were not available. Conclusions: The method enables the surgeon to remove the lymph nodes no. 10 along with 11p and 11d without needing to sacrifice the spleen. All spleens were reattached sucessfully using the preserved spleno-renal ligament fold, no wandering spleen was noticed.

Background: Incisional hernias are predominantly treated through open or laparoscopic surgery, with each method influencing recovery and patient-reported outcomes. This underscores the need for reliable assessment tools such as the EuraHS-QoL questionnaire to evaluate quality of life after surgery. Methods: This prospective single-center study was aimed at evaluating aestethic outcomes and patient satisfaction following laparoscopic versus open hernia repair. It involved 222 patients categorized by type of approach. The EuraHS-QoL questionnaire was used preoperatively and at 1- and 3-months post-surgery, with data analysis performed using Origin Pro 2018 and SPSS software version 28.0. Results: Among the participants, 152 were females and 70 males, with 78% undergoing open surgery and 22% laparoscopic. Findings revealed superior patient outcomes with laparoscopic repair in terms of pain management, daily activities, and aesthetic satisfaction. Patients reported significantly lower pain levels and fewer restrictions in daily activities post-laparoscopic surgery. While initial postoperative cosmetic results favored laparoscopic methods, the perceived differences in abdominal shape diminished over time. Conclusions: Laparoscopic repair significantly improves quality of life compared to open surgery, as shown by EuraHS-QoL scores. These results support the use of laparoscopic techniques in appropriate cases due to their benefits in pain reduction and faster functional recovery.

Background and aim: Enhanced Recovery After Surgery (ERAS) is a modern concept that aims to improve the perioperative patient care by implementing an evidence-based, patient-centered team approach. This paper aims to analyze the outcome, variations and limits of the ERAS-protocols used for laparoscopic cholecystectomy. Methods: We performed a systematic review on PubMed, Google Scholar, Web of Science to document the outcomes of applying various ERAS protocols in laparoscopic cholecystectomy (LC). After applying the inclusion and exclusion criteria, 8 papers, totaling 1453 patients that underwent LC, were included in the qualitative analysis. ERAS-protocols applied in those studies include various pre-, intra- and postoperative measures intended to boost the surgical recovery of the patients and shorten their hospital stay, without exposing them to hazardous encounters. Results: Patients undergoing laparoscopic cholecystectomy within an ERAS-specific protocol are proven to have lower levels of postoperative pain, nausea and vomiting, with no statistically significant risk of postoperative complications. The postoperative results show that ERAS-laparoscopic cholecystectomy is a feasible and safe procedure, that may shorten the postoperative recovery after LC. Conclusions: Further studies are needed to establish a consensus regarding the perioperative protocol, before implementing ERAS for LC in clinical routine.

Background: This non-randomized study aimed to compare the efficacy of two pharmacological treatments, "around-the-clock" analgesic treatment (ACAT) and "on-demand" analgesic treatment (ODAT), for managing postoperative pain following hemorrhoidectomy. Material and Methods: The study, conducted from July 2016 to December 2020, included 5335 hemorrhoidectomy patients. Participants were divided into ACAT (3767) and ODAT (1568) groups. The study was registered at clinicaltrials.gov (NCT04953182). Results: Patients had a mean age of 47.47 years, with 59.98% males. Postoperatively, 14.13% reported severe pain, 36.49% moderate, 34.28% mild, and 15.09% no pain. ACAT group's maximum pain was 3.04 (VAS), ODAT 4.95 (p; average pain was 0.79 (ACAT) and 1.45 (ODAT). Discharge pain was 0.42 (ACAT) and 0.63 (ODAT) VAS. The ACAT group consistently reported lower levels of pain across all measured instances. Higher BMI and younger age were pain risk factors (p=.049, p .001 respectively). ACAT administration resulted in reduced opioid usage, with meperidine showing a 68.38% decrease, morphine 43.57% less, tramadol 46.82% less, oxycodone reduced by 38.74%, and codeine by 53.40%. Additionally, the use of non-opioid analgesics was notably lower in the ACAT group, ranging from 16% to 59% less compared to the ODAT group. Conclusion: Hemorrhoidectomy induces moderate postoperative pain, with only 14% experiencing severe pain. A fixed schedule multimodal pain regimen, regardless of procedure and anesthesia type, reduces pain from moderate to mild post-hemorrhoidectomy. This approach also decreases opioid and non-opioid analgesic requirements. Higher BMI and younger age are identified as risk factors for elevated postoperative pain.

Liver transplantation is the last life-saving solution for patients with end stage liver disease. The low number of available liver grafts and the increasing waiting time on transplant lists have led to the appearance of extended donation criteria and the marginal grafs, initially considered suboptimal. Allocation of grafts and identification of the most suitable "donor-recipient" pair is still under development. The fact is that the appearance of marginal grafts has expanded the donation lists and seems to have a prognosis at least comparable to the use of ideal grafts.

Introduction: Pelvic organ prolapse is the most frequent and common health problem faced by most patients, representing the descent into the vagina or beyond the introitus of one or more pelvic organs, involving three compartments: anterior-bladder, apical-uterus and posterior-rectus. Lateral hystero/colpopexy is an alternative approach in the repair of symptomatic anterior and apical pelvic prolapse. The main objective is to correct pelvic floor defects, restore anatomy, relieve pressure and maintain normal sexual function. Material and Methods: Surgical intervention was applied to patients with prolapse greater than grade II according to the international prolapse quantification system (POP-Q). For apical, anterior prolapse, the bladder peritoneum is dissected and a polypropylene mesh is fitted to the round ligaments with suspension of the isthmus and cervix and fixation of the mesh with CapSure tacks followed by closure of the vaginal peritoneum. Results: During the performance of the technique I had no intraoperative or postoperative complications. Conservation of the uterus proved to be effective for prolapse correction, significant improvements in patient quality of life, frequency of nocturia, degree of dyspareunia and urgency symptoms were observed. Conclusion: Uterine preservation by lateral hystero/colpopexy is a new, feasible and successful method for treating prolapse.