Chirurgia最新文献

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.

Ischemia time is a well-established determinant of liver transplant outcomes. Patient survival is substantially affected by prolonged warm (WIT) and cold ischemia time (CIT) of the graft during liver transplant. One component that may be a contributing factor to both WIT and CIT is back bench time (BBT). We have identified BBT as a potentially significant underlying cause of post transplant complications.A literature search was performed using the major available databases. Articles comparing grafts using normothermic machine perfusion and static cold storage with measured WIT and CIT, and post-transplant outcomes, were included. A total of 18 studies were selected; however, we were only able to identify two studies that refer to BBT. In this systematic review, we conclude BBT is a modifiable factor of ischemia that may be impacted by the surgeon experience and requires more in depth studies to fully understand a safe threshold and its effect on post transplant outcomes such as EAD, IC, and graft survival.

Helicobacter pylori (H. pylori), a Gram-negative bacterium, has been classified as a Group I carcinogen by the World Health Organization. It represents the most significant modifiable risk factor for gastric cancer (GC), particularly the intestinal subtype. Although global infection rates are on the decline, its role in gastric oncogenesis remains prominent, especially in areas with elevated incidence rates. This review consolidates current insights into the molecular and immunological pathways through which H. pylori contributes to gastric tumorigenesis, with a focus on epigenetic modulation, host-microbe interactions, and the influence of the gastric microbiota. Chronic inflammation, instigated by H. pylori infection, advances through the Correa cascade, culminating in neoplastic transformation. Principal virulence determinants, including CagA and VacA, compromise epithelial barriers and initiate oncogenic signaling networks such as NF-úB, STAT3, Wnt/ò-catenin, and Hippo/YAP. The infection is also associated with extensive epigenetic remodeling, notably promoter hypermethylation of tumor suppressor genes like CDH1, and regulation of non-coding RNAs (including miRNAs, lncRNAs, and circRNAs). Sustained colonization drives immune polarization toward Th1 and Th17 responses, promotes immune escape mechanisms such as PD-L1 overexpression, and alters the composition of the gastric microbiome. Recent findings highlight the potential role of non-H. pylori microbial species in supporting tumor progression. While eradication of H. pylori lowers the risk of gastric cancer, it does not confer complete protection, particularly in individuals with pre-existing mucosal alterations or microbial dysbiosis. The development of H. pylori-associated gastric cancer is a multifactorial process, shaped by microbial virulence, host genetics, epigenetic shifts, and immune dynamics. A deeper understanding of these interrelated mechanisms is crucial for refining preventive measures, diagnostic accuracy, and therapeutic approaches.

The celiac trunk (CT), as the first major ventral branch of the abdominal aorta, plays a critical role in the vascularization of foregut-derived organs, including the stomach, liver, spleen, pancreas, and proximal duodenum. While the classic trifurcation pattern, known as Tripus Halleri, is observed in the majority of individuals, numerous studies have highlighted a remarkable degree of anatomical variability in its branching pattern, origin, and structural characteristics. This narrative review explores the embryological foundations, physiological anatomy, and clinical implications of CT variations, drawing upon historical and contemporary classifications - from Haller's descriptive observations to the structured systems proposed by Lipshutz, Michels, and Panagouli. Notably, deviations such as bifurcation, tetrafurcation, and even heptafurcation of the CT have been documented, with implications ranging from surgical risk in hepatobiliary procedures to complications in liver transplantation. The variability in CT morphology, influenced by developmental, genetic, and potentially ethnic factors, underscores the need for thorough anatomical knowledge in radiological diagnostics and surgical planning. By synthesizing findings from over four decades of cadaveric, radiological, and clinical studies, this review aims to provide a comprehensive understanding of CT anomalies and their relevance in modern clinical practice.

Background: Grade II ischemia in sigmoid volvulus presents challenges in surgical decision-making. This study compares outcomes between patients undergoing sigmoid resection during the first episode versus at recurrence. Methods: A retrospective analysis of 63 patients with intraoperatively confirmed Grade II ischemia treated between 2018-2024 was performed. All underwent initial endoscopic decompression followed by surgical resection - either during the first episode (Group I, n=41) or at recurrence (Group II, n=22). Demographic, biochemical, and surgical outcomes were compared. Results: Biochemical markers - including white blood cell count, CRP, D-dimer, serum lactate, and creatinine - were significantly elevated in recurrent cases (all p 0.001). Lower blood pH values were observed in recurrent cases (7.23 vs. 7.29, p 0.001) consistent with systemic acidosis. Operative time and intraoperative blood loss were higher in the recurrent group, and primary anastomosis was performed only in the first-episode group. Postoperative complications were more common in recurrent cases (31.8% vs. 12.2%, p=0.064), and length of stay was longer (8.64 vs. 6.32 days, p 0.001). Conclusions: Delayed surgery at recurrence is associated with worsened inflammation, metabolic derangement, and higher surgical risk. Early surgery during the first episode offers better clinical outcomes.

Background: Acute appendicitis is a common surgical emergency, predominantly affecting young males. Although laparoscopic appendectomy reduces adverse outcomes, potential complications related to this condition are known. Among these, hepatic abscess is a rare and severe complication, with limited cases reported in the literature. Case Report: We report a case of an 18-years-old male with diffuse purulent peritonitis due to perforated appendicitis who developed a hepatic abscess one month post-surgery. Despite the initial management including surgical intervention and antibiotic therapy, after one month the patient presented with high temperature and right upper quadrant pain, leading to the discovery and subsequent percutaneous drainage of a hepatic abscess and intravenous antibiotic therapy. The abscess culture identified Bacteroides Fragilis, guiding targeted antibiotic therapy and resulting in a full recovery. Discussion: This case highlights the potential for hepatic abscess formation following acute appendicitis, suspected to arise from hematogenous bacterial spread. Given the uncommon nature of this complication, a high index of suspicion in patients presenting with unusual symptoms post-appendectomy is required. Immediate percutaneous drainage alongside broad-spectrum antibiotic therapy, followed by targeted treatment upon pathogen identification, is crucial for managing this life-threatening condition. Conclusion: Although rare, hepatic abscess can occur as a complication of acute appendicitis, underscoring the importance of awareness and prompt intervention to prevent severe outcomes. Percutaneous drainage of the abscess associated to a targeted antibiotic therapy represents the treatment of choice.

Background: Obesity has emerged as a global pandemic, manifesting as metabolic, social, and psychological disorders. Traditional bariatric approaches have long been the cornerstone of obesity treatment; however, laparoscopic greater curvature plication (LGCP) has gained recognition as a viable, minimally invasive alternative. Aim of the study: The aim of this study is to evaluate the impact of LGCP on weight loss, obesity-related comorbidities, and quality of life in patients with a Body Mass Index (BMI) =35 kg/m². Materials and Methods: A retrospective analysis was conducted on 50 patients (45 women and 5 men) who underwent LGCP. The average preoperative BMI was 38.71 kg/m². Inclusion criteria targeted patients with a BMI =35 kg/mò with obesity-related comorbidities or =40 kg/m² regardless of comorbidity status. Preoperative and postoperative data collection included BMI measurements, comorbidity status, and quality of life, assessed through the Bariatric Analysis and Reporting Outcome System (BAROS) questionnaire. Results: At one year postoperatively, the average excess body weight loss percentage (EBWL%) reached 64.43%, peaking at 79.31% at 18 months, with stabilization at 65.13% by the two-year mark. The average BMI decreased from 38.71 kg/m² preoperatively to 30.35 kg/m² at two years postoperatively. Obesity-related comorbidities showed significant improvement: 15 out of 16 patients with dyslipidemia and 10 out of 12 with hyperglycemia experienced resolution or improvement, while all 18 patients with joint pain reported symptom relief. Conclusions: LGCP has proven to be an effective bariatric procedure, delivering substantial weight loss and improving obesity-related conditions and QOL in patients with a BMI =35 kg/m². Despite these favorable outcomes, long-term success remains contingent on patient adherence to lifestyle modifications and postoperative guidelines.

Introduction: Retinoblastoma is the most common pediatric ocular tumor and the lack of proper genetic testing and case registration represents an important cause for advanced stage disease at initial presentation. Material and Methods: A 10-year retrospective analysis of patients diagnosed with retinoblastoma between 2014- 2024 in â??Sf. Spiridonâ? Hospital, Iasi, Romania was performed, focusing on patient gender, age at presentation, Rb clinical stage, growth pattern, histological aspects and treatment type. Results: Unilateral tumors were found in 9/10 patients, one patient having bilateral tumor. Average age was 25.9 months, with 7 male and 3 female patients. All were diagnosed with disease stage E. Enucleation with successful tumor excision was performed in 6/7 cases. Two patients received conservative treatment and one patient was unable to be reached. 42.85% of tumors were classified as grade G2, and 57.15% as G3. 71.42% of cases had optic disc invasion with further nerve invasion in 40%. Uveal invasion was present in 57.14% of cases. Conclusion: This analysis provides insights into treatment options and long-term prognosis for children with retinoblastoma from the north-eastern part of Romania. This analysis highlights the need to enhance screening measures for infants, because of the advanced stage of retinoblastoma at presentation.

Introduction: We report our experience of six patients admitted to our hospital during January - July 2023 with complex aortic conditions treated with a two-stage hybrid procedure, consisting of surgical debranching - bypass grafting - of the supra-aortic branches off-pump and stent graft placement for Thoracic Endovascular Aortic Repair (TEVAR). Clinical features: The clinical cases we present highlight the use of TEVAR in both chronic (Type B aortic dissections, pseudoaneurysms, and penetrating aortic ulcers) and acute conditions (traumatic aortic transections and ruptured aortic aneurysms). TEVAR is a less invasive surgical approach for management of these critical patients, having as benefits: smaller incisions, avoiding operative risks associated with the classical procedure, shorter recovery time after the intervention and lower hospitalization costs. Conclusions: TEVAR offers an alternative to open surgery, showing better immediate and mid-term results, as well as providing the chance to solve a variety of both chronic and acute cases that would be otherwise classified as too high risk for classic open surgery.

Acute pancreatitis is a serious inflammatory condition of the pancreas that can be life-threatening, with the approach to treatment depending on the severity of the disease. Diagnosing acute pancreatitis, predicting its severity, and assessing prognosis generally involve imaging techniques like computed tomography, magnetic resonance imaging and ultrasound, along with scoring systems such as Ranson, Acute Physiology and Chronic Health Evaluation II (APACHE II), and the Bedside Index for Severity in Acute Pancreatitis (BISAP). Computed tomography is regarded as the gold standard due to its high sensitivity and specificity, while magnetic resonance imaging and ultrasound offer valuable insights into biliary obstruction and vascular issues. These scoring systems help categorize patients based on clinical and laboratory data into mild, moderate, or severe levels, influencing treatment decisions like intensive care unit admission, early enteral feeding, and the use of antibiotics. However, despite the importance of these imaging and scoring methods in managing acute pancreatitis, they face challenges in terms of accuracy, consistency, practicality, and cost-effectiveness. In this review we aimed at discussing the clinical usefulness of the most important scoring systems for prediction of severity in this complex disease.