R. Yarema, M. Оhorchak, O. Petronchak, R. Huley, P. Hyrya, Y. Kovalchuk, V. Safiyan, O. Rilinh, M. Matusyak
Peritoneal metastases are commonly associated with gastric cancer (GC) recurrence after radical treatment. Thus, patients at a high risk of peritoneal relapse require adjuvant intraperitoneal chemotherapy during the initial treatment. Along with clinical and morphological predictors of peritoneal relapse, another approach in surgical oncology is proving to be promising today. It refers to the prediction of the risk of developing metachronous peritoneal metastases in various molecular types of GC. Objective — to study the risk of peritoneal relapse in patients with the genomically stable type of GC in comparison to its other molecular types. Materials and methods. 37 patients with GC were enrolled into the study and evaluated after the radical treatment. 19 (51.4 %) patients formed a subgroup with peritoneal relapse and 18 patients (48.6 %) were included into a subgroup without metachronous carcinomatosis in the long term. All patients underwent immunohistochemical study for the E‑cadherin (CDH1 gene) expression in a gastric tumor. The genomically stable molecular type was identified on the basis of the aberrant E‑cadherin (CDH1‑mutated) tumor phenotype detection. Results. There was a statistically significant difference (p = 0.022, χ2 = 5.22) in the degree of aberrant E‑cadherin expression in subgroups of patients with and without peritoneal relapse — 68.4 and 33.3 %, respectively. Hence, it was noted that the genomically stable molecular type had a significant influence on the risk of peritoneal recurrence: the 2‑year peritoneal relapse‑free survival of GC patients with E‑cadherin of aberrant type was 31.6 %, and in GC patients with wild‑type E‑cadherin expression — 71.4 % (p = 0.022). The 2‑year overall survival of GC patients with aberrant type E‑cadherin expression was 36.8 %, whereas in GC patients with E‑cadherin of the wild type — 77.8 % (p = 0.003). Conclusions. The study found that the genomically stable molecular type of GC may serve as a predictive factor associated with an increased probability of peritoneal relapse, as well as a prognostic factor due to its negative impact on patient prognosis. The genomically stable molecular type of GC may be used as a tool for forming a cohort of patients with indications for adjuvant intraperitoneal therapy.
{"title":"A genomically stable molecular type of gastric cancer as a predictor of peritoneal relapse after radical surgical treatment","authors":"R. Yarema, M. Оhorchak, O. Petronchak, R. Huley, P. Hyrya, Y. Kovalchuk, V. Safiyan, O. Rilinh, M. Matusyak","doi":"10.30978/gs-2022-1-28","DOIUrl":"https://doi.org/10.30978/gs-2022-1-28","url":null,"abstract":"Peritoneal metastases are commonly associated with gastric cancer (GC) recurrence after radical treatment. Thus, patients at a high risk of peritoneal relapse require adjuvant intraperitoneal chemotherapy during the initial treatment. Along with clinical and morphological predictors of peritoneal relapse, another approach in surgical oncology is proving to be promising today. It refers to the prediction of the risk of developing metachronous peritoneal metastases in various molecular types of GC. \u0000Objective — to study the risk of peritoneal relapse in patients with the genomically stable type of GC in comparison to its other molecular types. \u0000Materials and methods. 37 patients with GC were enrolled into the study and evaluated after the radical treatment. 19 (51.4 %) patients formed a subgroup with peritoneal relapse and 18 patients (48.6 %) were included into a subgroup without metachronous carcinomatosis in the long term. All patients underwent immunohistochemical study for the E‑cadherin (CDH1 gene) expression in a gastric tumor. The genomically stable molecular type was identified on the basis of the aberrant E‑cadherin (CDH1‑mutated) tumor phenotype detection. \u0000Results. There was a statistically significant difference (p = 0.022, χ2 = 5.22) in the degree of aberrant E‑cadherin expression in subgroups of patients with and without peritoneal relapse — 68.4 and 33.3 %, respectively. Hence, it was noted that the genomically stable molecular type had a significant influence on the risk of peritoneal recurrence: the 2‑year peritoneal relapse‑free survival of GC patients with E‑cadherin of aberrant type was 31.6 %, and in GC patients with wild‑type E‑cadherin expression — 71.4 % (p = 0.022). The 2‑year overall survival of GC patients with aberrant type E‑cadherin expression was 36.8 %, whereas in GC patients with E‑cadherin of the wild type — 77.8 % (p = 0.003). \u0000Conclusions. The study found that the genomically stable molecular type of GC may serve as a predictive factor associated with an increased probability of peritoneal relapse, as well as a prognostic factor due to its negative impact on patient prognosis. The genomically stable molecular type of GC may be used as a tool for forming a cohort of patients with indications for adjuvant intraperitoneal therapy. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77391056","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}
Proctocolectomy with an ileal pouch‑anal anastomosis is currently considered the procedure of choice for the majority of patients with ulcerative colitis. Certain controversies about pouch design and pouch‑anal anastomosis technique remain a matter of debate, and possible advantages of laparoscopic approach are still being discussed. Objective — to investigate short‑term and long‑term outcomes of laparoscopic and open restorative proctocolectomy for UC in terms of postoperative morbidity and pouch function depending on the three types of construction of a neorectum described in our research. Materials and methods. 86 patients with inflammatory bowel disease underwent one‑stage or two‑stage restorative proctocolectomy. The two ileal pouch configurations were used: S‑pouch — in 16 patients and J‑pouch — in 70 patients. Removal of the distal rectum and ileal pouch‑anal anastomosis were performed using transanal distal rectum mucosectomy followed by a handsewn pouch‑anal anastomosis (n = 45) or a double‑stapled technique (n = 31). Laparoscopic approach was applied in 39 patients, and open surgery — in 47 patients. The short‑term (30 days after surgery) and long‑term surgical outcomes were prospectively studied. The analysis of functional outcomes was based on the number of bowel movements a day, episodes of fecal incontinence, seepage, and urgency. Instrumental investigation included measurement of the anal sphincter pressures and ileal pouch threshold volume as well as the study of its residual volume. Statistical analysis was performed using SPSS statistical software. Results. There was no postoperative mortality. In the laparoscopic group, 4 (10.3 %) patients had early postoperative complications compared with 13 (27.7 %) patients in the open surgery group, but the difference was not statistically significant (Fisher exact test value is 0.0579 at p < 0.05). Pouch failure occurred in 4 patients. The second‑stage laparoscopic restorative procedure revealed the abdominal cavity almost free of adhesions in 19 (86.4 %) patients after laparoscopic total colectomy. The total number of early and late mucosectomy complications was significantly higher, 12 (75.0 %) vs. 10 (26.0 %) (p = 0.0018), in patients managed with a handsewn S pouch‑anal anastomosis than in patients treated with a J‑pouch‑anal anastomosis. Good functional outcomes were observed in 44 (51.0 %) patients. A strong negative correlation was found between the pouch threshold volume and the number of bowel movements per 24 hours (r = –0.7347, p < 0.0001). The seepage episodes were detected in 30 (34.8 %) patients. The resting anal sphincter pressure was the only measured parameter which correlated accurately with the number of day and night seepage episodes (r = –074, p < 0.0001). Conclusions. Good functional outcomes of construction of a neorectum were associated with the resting anal sphincter pressure (≥ 30 mm Hg) and ileal pouch threshold volume (150 — 250 ml). The S‑shaped and J‑shap
直结肠切除术联合回肠袋肛管吻合术目前被认为是大多数溃疡性结肠炎患者的选择。关于袋设计和袋-肛门吻合技术的某些争议仍然是争论的问题，腹腔镜方法可能的优势仍在讨论中。目的:根据我们研究中描述的三种类型的肿瘤直肠结构，探讨腹腔镜和开放式恢复性直结肠切除术治疗UC的短期和长期结果，包括术后发病率和袋功能。材料和方法。86例炎症性肠病患者接受了一期或两期恢复性直结肠切除术。采用两种回肠袋结构:S型袋16例，J型袋70例。切除远端直肠和回肠袋肛管吻合术采用经肛门直肠远端粘膜切除术，然后采用手工缝合袋肛管吻合术(n = 45)或双吻合术(n = 31)。39例患者采用腹腔镜入路，47例患者采用开放手术。对近期(术后30天)和远期手术结果进行前瞻性研究。功能结果的分析是基于每天排便次数、大便失禁、渗漏和急症的发作。仪器调查包括测量肛门括约肌压力和回肠袋阈值体积以及研究其残余体积。采用SPSS统计软件进行统计分析。结果。无术后死亡率。腹腔镜组术后早期并发症4例(10.3%)，开放组13例(27.7%)，差异无统计学意义(Fisher精确检验值为0.0579,p < 0.05)。4例患者出现眼袋衰竭。第二期腹腔镜恢复性手术显示19例(86.4%)患者在腹腔镜全结肠切除术后腹腔几乎无粘连。手工缝合S袋-肛门吻合术患者早期和晚期粘膜切除术并发症总数明显高于J袋-肛门吻合术患者，分别为12例(75.0%)和10例(26.0%)(p = 0.0018)。44例(51.0%)患者观察到良好的功能预后。发现袋阈值体积与每24小时排便次数之间存在很强的负相关(r = -0.7347, p < 0.0001)。渗漏30例(34.8%)。静息肛门括约肌压力是唯一与白天和夜间渗漏次数准确相关的测量参数(r = -074, p < 0.0001)。结论。构建新直肠的良好功能结果与静息肛门括约肌压力(≥30 mm Hg)和回肠袋阈值体积(150 - 250 ml)相关。S形眼袋和J形眼袋表现出相同的功能结果和相似的风险。S袋与较高的术后发病率相关(p = 0.0018)。腹腔镜组和开放手术组在发病率和功能结局方面无显著差异。然而，由于较少粘连形成，腹腔镜手术后进行第二阶段手术要容易得多。
{"title":"Prospective analysis of surgical and functional outcomes after total proctocolectomy with ileal pouch-anal anastomosis in 86 patients with ulcerative colitis","authors":"M. Kucher","doi":"10.30978/gs-2022-1-19","DOIUrl":"https://doi.org/10.30978/gs-2022-1-19","url":null,"abstract":"Proctocolectomy with an ileal pouch‑anal anastomosis is currently considered the procedure of choice for the majority of patients with ulcerative colitis. Certain controversies about pouch design and pouch‑anal anastomosis technique remain a matter of debate, and possible advantages of laparoscopic approach are still being discussed. \u0000Objective — to investigate short‑term and long‑term outcomes of laparoscopic and open restorative proctocolectomy for UC in terms of postoperative morbidity and pouch function depending on the three types of construction of a neorectum described in our research. \u0000Materials and methods. 86 patients with inflammatory bowel disease underwent one‑stage or two‑stage restorative proctocolectomy. The two ileal pouch configurations were used: S‑pouch — in 16 patients and J‑pouch — in 70 patients. Removal of the distal rectum and ileal pouch‑anal anastomosis were performed using transanal distal rectum mucosectomy followed by a handsewn pouch‑anal anastomosis (n = 45) or a double‑stapled technique (n = 31). Laparoscopic approach was applied in 39 patients, and open surgery — in 47 patients. The short‑term (30 days after surgery) and long‑term surgical outcomes were prospectively studied. The analysis of functional outcomes was based on the number of bowel movements a day, episodes of fecal incontinence, seepage, and urgency. Instrumental investigation included measurement of the anal sphincter pressures and ileal pouch threshold volume as well as the study of its residual volume. Statistical analysis was performed using SPSS statistical software. \u0000Results. There was no postoperative mortality. In the laparoscopic group, 4 (10.3 %) patients had early postoperative complications compared with 13 (27.7 %) patients in the open surgery group, but the difference was not statistically significant (Fisher exact test value is 0.0579 at p < 0.05). Pouch failure occurred in 4 patients. The second‑stage laparoscopic restorative procedure revealed the abdominal cavity almost free of adhesions in 19 (86.4 %) patients after laparoscopic total colectomy. The total number of early and late mucosectomy complications was significantly higher, 12 (75.0 %) vs. 10 (26.0 %) (p = 0.0018), in patients managed with a handsewn S pouch‑anal anastomosis than in patients treated with a J‑pouch‑anal anastomosis. Good functional outcomes were observed in 44 (51.0 %) patients. A strong negative correlation was found between the pouch threshold volume and the number of bowel movements per 24 hours (r = –0.7347, p < 0.0001). The seepage episodes were detected in 30 (34.8 %) patients. The resting anal sphincter pressure was the only measured parameter which correlated accurately with the number of day and night seepage episodes (r = –074, p < 0.0001). \u0000Conclusions. Good functional outcomes of construction of a neorectum were associated with the resting anal sphincter pressure (≥ 30 mm Hg) and ileal pouch threshold volume (150 — 250 ml). The S‑shaped and J‑shap","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89798696","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}
L. Zavernyĭ, T. Tarasiuk, Y. Tsiura, M. Kryvopustov
The article presents the professional and scientific path of Professor Volodymyr Opanasovych Karavaiev — the first professor of surgery, first head of the department, first organizer and first dean of the medical faculty of St. Volodymyr University, who worked at the university clinic (now Kyiv City Clinical Hospital No18).
{"title":"Professor Volodymyr Opanasovych Karavaiev — surgeon, scientist and innovator","authors":"L. Zavernyĭ, T. Tarasiuk, Y. Tsiura, M. Kryvopustov","doi":"10.30978/gs-2022-1-5","DOIUrl":"https://doi.org/10.30978/gs-2022-1-5","url":null,"abstract":"The article presents the professional and scientific path of Professor Volodymyr Opanasovych Karavaiev — the first professor of surgery, first head of the department, first organizer and first dean of the medical faculty of St. Volodymyr University, who worked at the university clinic (now Kyiv City Clinical Hospital No18).","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88941500","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}
Ivan M. Leshchyshyn, Y. Susak, O. I. Okhots’ka, P. Byk, L. Markulan, O. Panchuk
Chronic constipation is a frequently diagnosed heterogeneous pathology that significantly impairs the quality of life in all population groups and its frequency increases with age. It commonly affects up to 10 — 15 % of the population. There are numerous classifications of constipation due to a great number of disorders that cause it. The types of constipation are identified based on the etiology or mechanism of its development. Different criteria are used to specify the categorization of constipation, but it is still difficult to find one general classification including all types of constipation. The Rome IV criteria categorize disorders of chronic constipation into four subgroups. The treatment depends on the subtype. The significant increase of constipation cases is observed nowadays. This disorder is facilitated by a sedentary lifestyle, insufficient amount of fiber and fluid in the diet, a wide range of diseases that directly lead to the development of chronic constipation, congenital and acquired pathologies, abnormal intake of laxatives and opioids or a combination of these factors. Despite numerous publications on slow transit constipation, the latter is still the subject of research for many specialists. A lot of recent scientific works have been dedicated to the immunohistochemical studies of interstitial pacemaker cells. The numbers of markers they express were found. Consequently, the investigations of modern scientists are aimed to develop and implement new laboratory methods for determining the indications for surgical treatment depending on a diagnosed disorder of the intestinal neurophysiology. These methods will ensure a differentiated selection of patients for surgical treatment. The step approach to the diagnosis of chronic constipation allows choosing an adequate treatment method in order to improve symptoms, the quality of life, and patient satisfaction. The literature review indicates that surgery still remains the most radical treatment method for patients with slow transit constipation.
{"title":"Chronic constipation: modern view on the problem. A review","authors":"Ivan M. Leshchyshyn, Y. Susak, O. I. Okhots’ka, P. Byk, L. Markulan, O. Panchuk","doi":"10.30978/gs-2021-1-67","DOIUrl":"https://doi.org/10.30978/gs-2021-1-67","url":null,"abstract":"Chronic constipation is a frequently diagnosed heterogeneous pathology that significantly impairs the quality of life in all population groups and its frequency increases with age. It commonly affects up to 10 — 15 % of the population. There are numerous classifications of constipation due to a great number of disorders that cause it. The types of constipation are identified based on the etiology or mechanism of its development. Different criteria are used to specify the categorization of constipation, but it is still difficult to find one general classification including all types of constipation. The Rome IV criteria categorize disorders of chronic constipation into four subgroups. The treatment depends on the subtype. The significant increase of constipation cases is observed nowadays. This disorder is facilitated by a sedentary lifestyle, insufficient amount of fiber and fluid in the diet, a wide range of diseases that directly lead to the development of chronic constipation, congenital and acquired pathologies, abnormal intake of laxatives and opioids or a combination of these factors. Despite numerous publications on slow transit constipation, the latter is still the subject of research for many specialists. A lot of recent scientific works have been dedicated to the immunohistochemical studies of interstitial pacemaker cells. The numbers of markers they express were found. Consequently, the investigations of modern scientists are aimed to develop and implement new laboratory methods for determining the indications for surgical treatment depending on a diagnosed disorder of the intestinal neurophysiology. These methods will ensure a differentiated selection of patients for surgical treatment. The step approach to the diagnosis of chronic constipation allows choosing an adequate treatment method in order to improve symptoms, the quality of life, and patient satisfaction. The literature review indicates that surgery still remains the most radical treatment method for patients with slow transit constipation. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85858702","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}
The article describes the professional and scientific way of professor Volodymyr Serhiyovych Zemskov, a prominent Ukrainian surgeon and a founder of the Kyiv Center for Liver, Bile Ducts and Pancreas Surgery which is currently based in the Kyiv City Clinical Hospital No10. The article presents the memories of his students and contemporaries, the facts about his professional biography and career development. The paper describes the main scientific interests of Volodymyr Zemskov, his achievements and scientific work.
{"title":"Professor Volodymyr Zemskov — a world-renowned Ukrainian surgeon","authors":"Y. Susak, S. Zemskov, D. Dubenko","doi":"10.30978/gs-2021-1-6","DOIUrl":"https://doi.org/10.30978/gs-2021-1-6","url":null,"abstract":"The article describes the professional and scientific way of professor Volodymyr Serhiyovych Zemskov, a prominent Ukrainian surgeon and a founder of the Kyiv Center for Liver, Bile Ducts and Pancreas Surgery which is currently based in the Kyiv City Clinical Hospital No10. The article presents the memories of his students and contemporaries, the facts about his professional biography and career development. The paper describes the main scientific interests of Volodymyr Zemskov, his achievements and scientific work. \u0000","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80925371","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}
A rare and unpredictable complication of firearm and missile injuries is projectile embolism. With only a few cases described in the literature, bullet embolism may become a diagnostic challenge for emergency physicians and military surgeons. Bullet embolization is a rare phenomenon, but the complications can be devastating. Case presentation. A 34‑year‑old man sustained a severe complex abdominoskeletal mine‑blast injury with damage to the hollow organs (duodenum and transverse colon), inferior vena cava and both low extremities. The internal hemorrhage was stopped by phleborrhaphy. The wounds of the duodenum and large intestine were sutured, and gunshot fractures of both anticnemions were stabilized by extrafocal osteosynthesis. The whole‑body CT showed that there was a projectile embolus into the branch of the right mid‑lobe pulmonary artery. No clinical manifestations of pulmonary artery embolism were observed in the patient. After surgery, he developed multiple necrosis and transverse colon perforations that resulted in fecal peritonitis. The suture line leakage that caused the formation of a duodenal fistula and postoperative wound infection were also detected. The complications were managed by multiple reoperations. The attempts of endovascular bullet extraction weren’t undertaken due to severe concomitant injuries, complications and asymptomatic clinical course of pulmonary artery projectile embolism. Open surgery retrieval of the embolus was successfully performed on the 80th day after injury. The patient was discharged from the hospital in good condition on the 168th day after the missile wound. Conclusions. Patients with missile wounds and no exit gunshot perforation should be examined using the whole‑body CT for determining possible migration of a projectile with the blood flow. Patients with asymptomatic pulmonary artery embolism should be managed nonoperatively. In case of symptomatic pulmonary artery projectile embolism, it is reasonable to consider the possibility of open thoracic surgery.
{"title":"Associated projectile inferior vena cava wound with subsequent pulmonary artery missile embolization: a case report and literature review","authors":"I. Tsema, I. Khomenko, Y. Susak, D. Dubenko","doi":"10.30978/gs-2021-1-48","DOIUrl":"https://doi.org/10.30978/gs-2021-1-48","url":null,"abstract":"A rare and unpredictable complication of firearm and missile injuries is projectile embolism. With only a few cases described in the literature, bullet embolism may become a diagnostic challenge for emergency physicians and military surgeons. Bullet embolization is a rare phenomenon, but the complications can be devastating.\u0000Case presentation. A 34‑year‑old man sustained a severe complex abdominoskeletal mine‑blast injury with damage to the hollow organs (duodenum and transverse colon), inferior vena cava and both low extremities. The internal hemorrhage was stopped by phleborrhaphy. The wounds of the duodenum and large intestine were sutured, and gunshot fractures of both anticnemions were stabilized by extrafocal osteosynthesis. The whole‑body CT showed that there was a projectile embolus into the branch of the right mid‑lobe pulmonary artery. No clinical manifestations of pulmonary artery embolism were observed in the patient. After surgery, he developed multiple necrosis and transverse colon perforations that resulted in fecal peritonitis. The suture line leakage that caused the formation of a duodenal fistula and postoperative wound infection were also detected. The complications were managed by multiple reoperations. The attempts of endovascular bullet extraction weren’t undertaken due to severe concomitant injuries, complications and asymptomatic clinical course of pulmonary artery projectile embolism. Open surgery retrieval of the embolus was successfully performed on the 80th day after injury. The patient was discharged from the hospital in good condition on the 168th day after the missile wound.\u0000Conclusions. Patients with missile wounds and no exit gunshot perforation should be examined using the whole‑body CT for determining possible migration of a projectile with the blood flow. Patients with asymptomatic pulmonary artery embolism should be managed nonoperatively. In case of symptomatic pulmonary artery projectile embolism, it is reasonable to consider the possibility of open thoracic surgery.\u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88508586","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}
Graves' disease (GD) is a hereditary autoimmune disease which is characterized by persistent abnormal hypersecretion of thyroid hormones and thyrotoxicosis syndrome development. GD affects from 0.5 % to 2.0 % of population in different regions. 46 % of these patients develop ophthalmopathy. GD is a common cause of disabilities in patients under 60 years of age. In recent years, the incidence of GD in Ukraine has increased by 9.9 % — from 106.2 to 117.9 per 100,000 individuals. This can be connected with the improved diagnostic possibilities and active disease detection as well as with the increased number of autoimmune thyroid disorders. The recent studies focus on prevention of specific complications and recurrences of GD after surgery. Objective — to compare the levels of antibodies to the thyroid‑stimulating hormone receptors (TSHR‑Ab) during different postoperative periods as well as the incidence of early and late complications depending on the surgical technique used for the treatment of GD. Materials and methods. The results of surgical treatment of 130 patients, with GD were compared. 29 male patients and 101 female patients aged from 19 to 76 (average — 44.1 ± 3.2 years), receiving their treatment for GD in Kyiv Center of Endocrine Surgery during 2010—2018, were randomly selected and divided into two groups. At the time of operation the duration of disease was from 1 to 30 years (average — 4.6 ± 1.2 years). Group 1 included 65 patients that underwent total thyreoidectomy (TT) and group 2 included 65 patients that underwent subtotal thyreoidectomy (ST). The following parameters were compared: surgery duration, the incidence of early postoperative complications, including bleedings and damage to the recurrent laryngeal nerves, and late outcomes of surgical treatment (persistent hypoparathyreoidism disorder and disorder recurrences) depending on the method of surgery (ST or TT). Furthermore, the patterns of the TSHR‑Ab level reduction were studied for different postoperative periods. Results. The comparison of surgical outcomes following TТ and ST didn’t reveal any statistically significant differences in such evaluation criteria as the average surgery duration, the average volume of intraoperative blood loss and the average duration of the postoperative inpatient treatment. The comparative assessment of the thyroid stump volume and the average amount of drained discharge showed statistically significant differences for TТ. It allows considering TТ as a surgery which causes less complications than ST. The studied parameters of early postoperative complications had no significant differences for ST and TТ. The long‑term (5 years) postoperative level of TSHR‑Ab was statistically significantly lower in patients after TT and made up 1.15 ± 0.13 IU/L (thus corresponding to the normal level). Conclusions. Total thyroidectomy is an optimal surgical technique and is more appropriate compared with subtotal thyroid gland resection. It should be note
{"title":"Results obtained after the surgical treatment of Graves’ disease depending on the levels of anti-thyroid antibodies","authors":"S. Shliakhtych, V. Antoniv","doi":"10.30978/gs-2021-1-36","DOIUrl":"https://doi.org/10.30978/gs-2021-1-36","url":null,"abstract":"Graves' disease (GD) is a hereditary autoimmune disease which is characterized by persistent abnormal hypersecretion of thyroid hormones and thyrotoxicosis syndrome development. GD affects from 0.5 % to 2.0 % of population in different regions. 46 % of these patients develop ophthalmopathy. GD is a common cause of disabilities in patients under 60 years of age. In recent years, the incidence of GD in Ukraine has increased by 9.9 % — from 106.2 to 117.9 per 100,000 individuals. This can be connected with the improved diagnostic possibilities and active disease detection as well as with the increased number of autoimmune thyroid disorders. The recent studies focus on prevention of specific complications and recurrences of GD after surgery.\u0000Objective — to compare the levels of antibodies to the thyroid‑stimulating hormone receptors (TSHR‑Ab) during different postoperative periods as well as the incidence of early and late complications depending on the surgical technique used for the treatment of GD.\u0000Materials and methods. The results of surgical treatment of 130 patients, with GD were compared. 29 male patients and 101 female patients aged from 19 to 76 (average — 44.1 ± 3.2 years), receiving their treatment for GD in Kyiv Center of Endocrine Surgery during 2010—2018, were randomly selected and divided into two groups. At the time of operation the duration of disease was from 1 to 30 years (average — 4.6 ± 1.2 years). Group 1 included 65 patients that underwent total thyreoidectomy (TT) and group 2 included 65 patients that underwent subtotal thyreoidectomy (ST). The following parameters were compared: surgery duration, the incidence of early postoperative complications, including bleedings and damage to the recurrent laryngeal nerves, and late outcomes of surgical treatment (persistent hypoparathyreoidism disorder and disorder recurrences) depending on the method of surgery (ST or TT). Furthermore, the patterns of the TSHR‑Ab level reduction were studied for different postoperative periods.\u0000Results. The comparison of surgical outcomes following TТ and ST didn’t reveal any statistically significant differences in such evaluation criteria as the average surgery duration, the average volume of intraoperative blood loss and the average duration of the postoperative inpatient treatment. The comparative assessment of the thyroid stump volume and the average amount of drained discharge showed statistically significant differences for TТ. It allows considering TТ as a surgery which causes less complications than ST. The studied parameters of early postoperative complications had no significant differences for ST and TТ. The long‑term (5 years) postoperative level of TSHR‑Ab was statistically significantly lower in patients after TT and made up 1.15 ± 0.13 IU/L (thus corresponding to the normal level).\u0000Conclusions. Total thyroidectomy is an optimal surgical technique and is more appropriate compared with subtotal thyroid gland resection. It should be note","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84900637","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}
Over the last few decades, excess weight and obesity have become a considerable health problem that has a lasting impact on communities worldwide. According to the WHO, about 1.9 billion people over the age of 18 are overweight [32]. Obesity accounted for about 4.7 million premature deaths in 2017. Globally, obesity was associated with an increase in mortality rate from 4.5 % in 1990 to 8 % in 2017 [32]. Bariatric surgery is currently recognized as the most effective treatment option for morbid obesity. Over the past 10 years, gastric bypass surgery has proved more effective than any other surgical methods due to its optimal metabolic effects. The aim of the review is to carry out an analysis of literature data in order to identify main complications after gastric bypass in patients with obesity. The complication rate after bariatric surgery decreased from 10.5 % in 1993 to 7.6 % in 2006 [3]. The mortality rate after bariatric surgery was 0.08 % within 30 days after surgery and 0.31 % after 30 days [13]. According to the BOLD study (2010), for 57,918 bariatric operations, the complication rate was 6,240 (10.77 %) and the mortality rate was 78 (0.135 %), within 30 days after surgery — 0.089 %, within 90 days after surgery — 0.112 %. Roux‑en‑Y Gastric Bypass (RYGB) was carried out in 30,864 cases, and 4,588 (14.87 %) patients developed postoperative complications. Early complications include anastomotic leaks (0 — 5,6 % for laparoscopic approach and 1,6 — 2,6 % — for laparotomy), small bowel obstruction caused by a blood clot (0 — 0,5 %), bleeding from the sutures (1,5 %), and thromboembolic complications (0,2 — 5 %). Late complications include stenosis of the gastrointestinal tract (3 — 27 %), marginal ulceration (MU) — 0,6 — 16 %, an incarcerated Petersen’s space hernia — 2,51 %, perforation of the stomach and small intestine (1 — 2 %), gastrogastric fistula formation — 1,5 — 6,0 %, weight regain (to 17,1 %). Increasing global demand for bariatric surgery as the best option for the management of excess weight and obesity necessitates more detailed investigation of possible complications it may induce. Therefore, further research is required to develop and study new effective methods for prevention and treatment of complications after surgical treatment of patients with morbid obesity.
{"title":"Early and late complications after gastric bypass: A literature review","authors":"V. O. Nevmerzhytskyi","doi":"10.30978/gs-2021-1-60","DOIUrl":"https://doi.org/10.30978/gs-2021-1-60","url":null,"abstract":"Over the last few decades, excess weight and obesity have become a considerable health problem that has a lasting impact on communities worldwide. According to the WHO, about 1.9 billion people over the age of 18 are overweight [32]. Obesity accounted for about 4.7 million premature deaths in 2017. Globally, obesity was associated with an increase in mortality rate from 4.5 % in 1990 to 8 % in 2017 [32]. Bariatric surgery is currently recognized as the most effective treatment option for morbid obesity. Over the past 10 years, gastric bypass surgery has proved more effective than any other surgical methods due to its optimal metabolic effects. \u0000The aim of the review is to carry out an analysis of literature data in order to identify main complications after gastric bypass in patients with obesity. \u0000The complication rate after bariatric surgery decreased from 10.5 % in 1993 to 7.6 % in 2006 [3]. The mortality rate after bariatric surgery was 0.08 % within 30 days after surgery and 0.31 % after 30 days [13]. According to the BOLD study (2010), for 57,918 bariatric operations, the complication rate was 6,240 (10.77 %) and the mortality rate was 78 (0.135 %), within 30 days after surgery — 0.089 %, within 90 days after surgery — 0.112 %. Roux‑en‑Y Gastric Bypass (RYGB) was carried out in 30,864 cases, and 4,588 (14.87 %) patients developed postoperative complications. Early complications include anastomotic leaks (0 — 5,6 % for laparoscopic approach and 1,6 — 2,6 % — for laparotomy), small bowel obstruction caused by a blood clot (0 — 0,5 %), bleeding from the sutures (1,5 %), and thromboembolic complications (0,2 — 5 %). Late complications include stenosis of the gastrointestinal tract (3 — 27 %), marginal ulceration (MU) — 0,6 — 16 %, an incarcerated Petersen’s space hernia — 2,51 %, perforation of the stomach and small intestine (1 — 2 %), gastrogastric fistula formation — 1,5 — 6,0 %, weight regain (to 17,1 %). \u0000Increasing global demand for bariatric surgery as the best option for the management of excess weight and obesity necessitates more detailed investigation of possible complications it may induce. Therefore, further research is required to develop and study new effective methods for prevention and treatment of complications after surgical treatment of patients with morbid obesity. \u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86437896","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}
Laparoscopic common bile duct exploration (LCBDE) performed by choledochoscope through the cystic duct or directly through the incision in the common bile duct (CBD) are well established methods for restoring biliary drainage function in patients with choledocholithiasis. Although it plays a crucial role in the transcystic approach, transductal approach can be achieved differently. However, it has restrictions in availability due to its expensiveness. Objective — to report efficacy of transductal LCBDE without laparoscopic choledochoscopy. Materials and methods. This is a prospective study of urgently admitted patients who underwent trans‑ductal LCBDE due to confirmed choledocholithiasis. During laparoscopy, clearance of the CBD was achieved in two ways: by choledochoscopy (group CS+, n = 43) and without it (group CS–, n = 34). The data of patient demographics, comorbidities, operative outcomes, morbidity, mortality and long‑term biliary complications were analysed and compared between the groups. Results. Out of a total of 154 patients with confirmed choledocholithiasis, the trans‑ductal approach of LCBDE was applied to 77 patients. In 43 patients, clearance was done with choledochoscope (group CS+) and in 34 patients without it (group CS–). Gallstone related complications and comorbidities did not differ between the groups. Surgery was done 4 days after admission in both groups. Median duration of the operation was significantly shorter in the group CS–, 93 vs 120 minutes (p = 0.036), without any difference in conversion and complication rates. Clearance rate was markedly high in both groups. Conclusions. Transductal laparoscopic common bile duct exploration without choledochoscopy is a time‑saving, safe and effective way for CBD clearance, without additional equipment.
{"title":"The role of choledochoscopy in transductal laparoscopic common bile duct exploration","authors":"K. Atstupens, H. Plaudis, E. Saukane, A. Rudzats","doi":"10.30978/gs-2021-1-10","DOIUrl":"https://doi.org/10.30978/gs-2021-1-10","url":null,"abstract":"Laparoscopic common bile duct exploration (LCBDE) performed by choledochoscope through the cystic duct or directly through the incision in the common bile duct (CBD) are well established methods for restoring biliary drainage function in patients with choledocholithiasis. Although it plays a crucial role in the transcystic approach, transductal approach can be achieved differently. However, it has restrictions in availability due to its expensiveness.\u0000Objective — to report efficacy of transductal LCBDE without laparoscopic choledochoscopy.\u0000Materials and methods. This is a prospective study of urgently admitted patients who underwent trans‑ductal LCBDE due to confirmed choledocholithiasis. During laparoscopy, clearance of the CBD was achieved in two ways: by choledochoscopy (group CS+, n = 43) and without it (group CS–, n = 34). The data of patient demographics, comorbidities, operative outcomes, morbidity, mortality and long‑term biliary complications were analysed and compared between the groups.\u0000Results. Out of a total of 154 patients with confirmed choledocholithiasis, the trans‑ductal approach of LCBDE was applied to 77 patients. In 43 patients, clearance was done with choledochoscope (group CS+) and in 34 patients without it (group CS–). Gallstone related complications and comorbidities did not differ between the groups. Surgery was done 4 days after admission in both groups. Median duration of the operation was significantly shorter in the group CS–, 93 vs 120 minutes (p = 0.036), without any difference in conversion and complication rates. Clearance rate was markedly high in both groups.\u0000Conclusions. Transductal laparoscopic common bile duct exploration without choledochoscopy is a time‑saving, safe and effective way for CBD clearance, without additional equipment.\u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81297751","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}
The inguinal hernia has an incidence of 27 — 43 % in males. Surgical repair is the most accepted treatment to prevent the development of complications. Laparoscopic inguinal hernia repair has become popular worldwide and includes the use of a laparoscopic technique for mesh placement behind the defect. Objective — to assess whether totally extraperitoneal (TEP) inguinal hernia repair shows benefits over Lichtenstein repair in intraoperative and one‑year follow‑up postoperative outcomes for male patients with primary unilateral inguinal hernia. Materials and methods. 53 males were randomly allocated to two groups. Group 1 included 27 patients who underwent totally extraperitoneal hernia repair using self‑gripping lightweight mesh, and group 2 included 26 patients who were treated surgically with Lichtenstein repair using lightweight mesh. Results. Both groups were comparable in mean age, type of hernia, body mass index and patient’s distribution according to the European hernia society classification. TEP repair takes on average a little less time as compared to Lichtenstein repair, and this difference is not statistically significant. The mean of visual analogue scale for pain scoring in the first 24 hours after surgery as well as in the next 24 hours is statistically significantly smaller in group 1 compared to group 2. The mean time taken to return to work was 2.15 times longer in group 2 than in group 1, and the difference was statistically significant. Conclusions. Totally extraperitoneal hernia repair shows potential benefits over Lichtenstein repair for primary unilateral inguinal hernias as it causes less pain in the postoperative period and ensures early return to work.
{"title":"Totally extraperitoneal inguinal hernia repair versus Lichtenstein repair: a one-year follow-up study","authors":"H. O. Havrylov, O. Shulyarenko","doi":"10.30978/gs-2021-1-31","DOIUrl":"https://doi.org/10.30978/gs-2021-1-31","url":null,"abstract":"The inguinal hernia has an incidence of 27 — 43 % in males. Surgical repair is the most accepted treatment to prevent the development of complications. Laparoscopic inguinal hernia repair has become popular worldwide and includes the use of a laparoscopic technique for mesh placement behind the defect.\u0000Objective — to assess whether totally extraperitoneal (TEP) inguinal hernia repair shows benefits over Lichtenstein repair in intraoperative and one‑year follow‑up postoperative outcomes for male patients with primary unilateral inguinal hernia.\u0000Materials and methods. 53 males were randomly allocated to two groups. Group 1 included 27 patients who underwent totally extraperitoneal hernia repair using self‑gripping lightweight mesh, and group 2 included 26 patients who were treated surgically with Lichtenstein repair using lightweight mesh.\u0000Results. Both groups were comparable in mean age, type of hernia, body mass index and patient’s distribution according to the European hernia society classification. TEP repair takes on average a little less time as compared to Lichtenstein repair, and this difference is not statistically significant. The mean of visual analogue scale for pain scoring in the first 24 hours after surgery as well as in the next 24 hours is statistically significantly smaller in group 1 compared to group 2. The mean time taken to return to work was 2.15 times longer in group 2 than in group 1, and the difference was statistically significant.\u0000Conclusions. Totally extraperitoneal hernia repair shows potential benefits over Lichtenstein repair for primary unilateral inguinal hernias as it causes less pain in the postoperative period and ensures early return to work.\u0000 ","PeriodicalId":12661,"journal":{"name":"General Surgery","volume":"7 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80333159","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}
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