Pub Date : 2022-03-01DOI: 10.9738/intsurg-d-20-00002.1
J. Ueda, H. Yoshida
We evaluated the effect of postgraduate surgical education on inguinal hernia repair for resident surgeons. A total of 93 adult patients underwent open mesh repairs for inguinal hernias. These patients were randomly assigned to junior or senior resident surgeon groups for inguinal hernia repairs. The surgical training program for inguinal hernia repair was subdivided into 3 consecutive steps: sections A, B, and C. The sections were defined as follows: (A) the starting point of the surgery to hanging the spermatic cord, (B) dissection of the hernia sac, and (C) placement of the hernia mesh. The time to complete each procedure was recorded. We then evaluated the learning curve of the junior resident surgeons for open mesh repair of inguinal hernia. The mean operative time of the junior resident group was significantly longer than that of the senior resident group. Particularly, the mean times of the junior residents for sections B and C were significantly longer than those of the senior resident group. However, the volume of intraoperative blood loss and the short-term outcomes were not significantly different between the groups. For section C of the procedure, the learning curve seemed shorter for junior resident surgeons who had completed the training program for inguinal hernia repair than that for junior resident surgeons who were just beginning this program. This study demonstrates that a junior resident surgeon's initial experience with hernia repair is associated with an identifiable learning curve when participating in a suitable training program.
{"title":"Learning Curve of Resident Surgeons for Open Mesh Repair of Inguinal Hernia","authors":"J. Ueda, H. Yoshida","doi":"10.9738/intsurg-d-20-00002.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00002.1","url":null,"abstract":"\u0000 \u0000 We evaluated the effect of postgraduate surgical education on inguinal hernia repair for resident surgeons.\u0000 \u0000 \u0000 \u0000 A total of 93 adult patients underwent open mesh repairs for inguinal hernias. These patients were randomly assigned to junior or senior resident surgeon groups for inguinal hernia repairs. The surgical training program for inguinal hernia repair was subdivided into 3 consecutive steps: sections A, B, and C. The sections were defined as follows: (A) the starting point of the surgery to hanging the spermatic cord, (B) dissection of the hernia sac, and (C) placement of the hernia mesh. The time to complete each procedure was recorded. We then evaluated the learning curve of the junior resident surgeons for open mesh repair of inguinal hernia.\u0000 \u0000 \u0000 \u0000 The mean operative time of the junior resident group was significantly longer than that of the senior resident group. Particularly, the mean times of the junior residents for sections B and C were significantly longer than those of the senior resident group. However, the volume of intraoperative blood loss and the short-term outcomes were not significantly different between the groups. For section C of the procedure, the learning curve seemed shorter for junior resident surgeons who had completed the training program for inguinal hernia repair than that for junior resident surgeons who were just beginning this program.\u0000 \u0000 \u0000 \u0000 This study demonstrates that a junior resident surgeon's initial experience with hernia repair is associated with an identifiable learning curve when participating in a suitable training program.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43831590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.9738/intsurg-d-16-00252.1
Ju-ying Jin, S. Min, Qibin Chen, Dong Zhang
To determine efficacy and safety of patient-controlled intravenous analgesia (PCIA) with tramadol and lornoxicam for postoperative analgesia, and its effects on surgical outcomes in patients after thoracotomy. Adequate pain relief after thoracic surgery is of particular importance, not only for keeping patients comfortable but also for reducing the incidence of postoperative complications. PCIA with tramadol and lornoxicam could be an acceptable alternative to patient-controlled epidural analgesia (PCEA) for pain management after thoracotomy. The records of patients who underwent thoracotomy for lung resection between January 2014 and December 2014 at our institution were reviewed. The patients were divided into 2 groups according to postoperative pain treatment modalities. Patients of PCEA group (n = 63) received PCEA with 0.2% ropivacaine plus 0.5 μg/mL sufentanil, while patients in PCIA group (n = 48) received PCIA with 5 mg/mL tramadol and 0.4 mg/mL lornoxicam. Data were collected for quality of pain control, incidences of analgesia-related side effects and pulmonary complications, lengths of thoracic intensive care unit stay and postoperative hospital stay, and in-hospital mortality. Pain at rest was controlled well in both groups during a 4-day postoperative period. Patients in PCIA group reported significantly higher pain scores on coughing and during mobilization in the first 2 postoperative days. The incidences of side effects and pulmonary complications, in-hospital mortality, and other outcomes were similar between groups. PCIA with tramadol and lornoxicam can be considered as a safe and effective alternative with respect to pain control and postoperative outcomes after thoracotomy.
{"title":"Patient-Controlled Intravenous Analgesia With Tramadol and Lornoxicam After Thoracotomy: A Comparison With Patient-Controlled Epidural Analgesia","authors":"Ju-ying Jin, S. Min, Qibin Chen, Dong Zhang","doi":"10.9738/intsurg-d-16-00252.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-16-00252.1","url":null,"abstract":"\u0000 \u0000 To determine efficacy and safety of patient-controlled intravenous analgesia (PCIA) with tramadol and lornoxicam for postoperative analgesia, and its effects on surgical outcomes in patients after thoracotomy.\u0000 \u0000 \u0000 \u0000 Adequate pain relief after thoracic surgery is of particular importance, not only for keeping patients comfortable but also for reducing the incidence of postoperative complications. PCIA with tramadol and lornoxicam could be an acceptable alternative to patient-controlled epidural analgesia (PCEA) for pain management after thoracotomy.\u0000 \u0000 \u0000 \u0000 The records of patients who underwent thoracotomy for lung resection between January 2014 and December 2014 at our institution were reviewed. The patients were divided into 2 groups according to postoperative pain treatment modalities. Patients of PCEA group (n = 63) received PCEA with 0.2% ropivacaine plus 0.5 μg/mL sufentanil, while patients in PCIA group (n = 48) received PCIA with 5 mg/mL tramadol and 0.4 mg/mL lornoxicam. Data were collected for quality of pain control, incidences of analgesia-related side effects and pulmonary complications, lengths of thoracic intensive care unit stay and postoperative hospital stay, and in-hospital mortality.\u0000 \u0000 \u0000 \u0000 Pain at rest was controlled well in both groups during a 4-day postoperative period. Patients in PCIA group reported significantly higher pain scores on coughing and during mobilization in the first 2 postoperative days. The incidences of side effects and pulmonary complications, in-hospital mortality, and other outcomes were similar between groups.\u0000 \u0000 \u0000 \u0000 PCIA with tramadol and lornoxicam can be considered as a safe and effective alternative with respect to pain control and postoperative outcomes after thoracotomy.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42588916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.9738/0020-8868-106.2.i
{"title":"Editorial Letter for International Surgery Issue 106 (2Q, 2022)","authors":"","doi":"10.9738/0020-8868-106.2.i","DOIUrl":"https://doi.org/10.9738/0020-8868-106.2.i","url":null,"abstract":"","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46197558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.9738/intsurg-d-20-00038.1
K. Ohta, M. Ikenaga, M. Ueda, Kiyotsugu Iede, Yujiro Tsuda, S. Nakashima, Tsukasa Tanida, T. Nojiri, J. Matsuyama, S. Endo, Terumasa Yamada
This study aimed to determine if induction of sodium picosulfate and magnesium citrate (SPMC) preparation leads to adequate surgery for left-sided colorectal cancer (CRC). Adequate bowel cleansing is vital for safe and accurate colorectal surgery. Ingestion of laxatives for bowel cleansing may be associated with a broad spectrum of adverse effects during surgical intervention. A single-center prospective study was conducted with hospitalized patients scheduled operation for left-sided CRC. All enrolled patients were instructed to consume normal diet until before preparation. Twenty-seven patients underwent preoperative SPMC preparation. The primary endpoint of this study was the 30-day postoperative morbidity rate, which was 23%, and no postoperative complication was higher than Clavien-Dindo grade 3. The primary anastomosis rate was 100%, and there was no anastomotic leakage. The colonic cleansing grades were 1 or 2 according to the bowel preparation scale for surgical assessment in 89% of the patients. The acceptability of the cleansing procedure by the patients assessed by a questionnaire was 85%, and the acceptability of the SPMC preparation by the medical staff was 93%. The surgical procedures included 18 laparoscopies, 6 robotic surgeries, and 3 laparotomies. The median operation time was 165 minutes, and the median blood loss was <50 cc. The median sodium serum concentration was significantly decreased after surgery. Ingestion of an SPMC preparation as a cleansing procedure was judged to be adequate for curative surgery in patients with left-sided colorectal cancer.
{"title":"Preoperative Oral-Bowel Preparation Using Sodium Picosulfate and Magnesium Citrate Combination Powder for Left-Sided Colorectal Cancer: A Prospective Study","authors":"K. Ohta, M. Ikenaga, M. Ueda, Kiyotsugu Iede, Yujiro Tsuda, S. Nakashima, Tsukasa Tanida, T. Nojiri, J. Matsuyama, S. Endo, Terumasa Yamada","doi":"10.9738/intsurg-d-20-00038.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00038.1","url":null,"abstract":"\u0000 \u0000 This study aimed to determine if induction of sodium picosulfate and magnesium citrate (SPMC) preparation leads to adequate surgery for left-sided colorectal cancer (CRC).\u0000 \u0000 \u0000 \u0000 Adequate bowel cleansing is vital for safe and accurate colorectal surgery. Ingestion of laxatives for bowel cleansing may be associated with a broad spectrum of adverse effects during surgical intervention.\u0000 \u0000 \u0000 \u0000 A single-center prospective study was conducted with hospitalized patients scheduled operation for left-sided CRC. All enrolled patients were instructed to consume normal diet until before preparation. Twenty-seven patients underwent preoperative SPMC preparation.\u0000 \u0000 \u0000 \u0000 The primary endpoint of this study was the 30-day postoperative morbidity rate, which was 23%, and no postoperative complication was higher than Clavien-Dindo grade 3. The primary anastomosis rate was 100%, and there was no anastomotic leakage. The colonic cleansing grades were 1 or 2 according to the bowel preparation scale for surgical assessment in 89% of the patients. The acceptability of the cleansing procedure by the patients assessed by a questionnaire was 85%, and the acceptability of the SPMC preparation by the medical staff was 93%. The surgical procedures included 18 laparoscopies, 6 robotic surgeries, and 3 laparotomies. The median operation time was 165 minutes, and the median blood loss was <50 cc. The median sodium serum concentration was significantly decreased after surgery.\u0000 \u0000 \u0000 \u0000 Ingestion of an SPMC preparation as a cleansing procedure was judged to be adequate for curative surgery in patients with left-sided colorectal cancer.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42981339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-18DOI: 10.9738/intsurg-d-21-00022.1
Kyohei Abe, Y. Futagawa, H. Shiba, K. Furukawa, S. Onda, Masaru Kanehira, T. Sakamoto, T. Uwagawa, Y. Ishida, K. Yanaga
Objective: Postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy is the most serious complication of these surgical procedures; therefore, we examine the effectiveness of fasting, and administration of octreotide acetate and ulinastatin as a method of prevention. Summary of Background Data : Although various drug therapies and surgical techniques have been used for the treatment of POPF, no decisive treatment for POPF exists. Methods: The clinical course of 30 patients who developed POPF was retrospectively evaluated and compared between no dietary intake (n=18), octreotide acetate (n=8), and ulinastatin (n=8) using an overlapping design. Patients were allocated to either the dietary intake or fasting (no dietary intake) group, and those in the no dietary intake group were further divided into the octreotide acetate or ulinastatin group. Results: Length of hospitalization was longer for the no dietary intake group than for the dietary intake group (p=0.002). When considering only grade B or C POPF cases, the no dietary intake group had a longer length of hospitalization and a higher white blood cell count on day 7 after the diagnosis of POPF than the dietary intake group (p<0.05). The white blood cell count was also higher in the octreotide acetate group than in the ulinastatin group (p=0.021). The length of hospitalization was shorter in the ulinastatin group than in the octreotide acetate group (p=0.025). Conclusions: The use of no dietary intake, octreotide acetate, and ulinastatin do not seem to contribute to the clinical course of patients with POPF after pancreatoduodenectomy.
{"title":"Effects of Fasting and Administration of Octreotide Acetate and Ulinastatin on Clinical Outcomes of Pancreatic Fistula after Pancreatoduodenectomy","authors":"Kyohei Abe, Y. Futagawa, H. Shiba, K. Furukawa, S. Onda, Masaru Kanehira, T. Sakamoto, T. Uwagawa, Y. Ishida, K. Yanaga","doi":"10.9738/intsurg-d-21-00022.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-21-00022.1","url":null,"abstract":"Objective: Postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy is the most serious complication of these surgical procedures; therefore, we examine the effectiveness of fasting, and administration of octreotide acetate and ulinastatin as a method of prevention. Summary of Background Data : Although various drug therapies and surgical techniques have been used for the treatment of POPF, no decisive treatment for POPF exists. Methods: The clinical course of 30 patients who developed POPF was retrospectively evaluated and compared between no dietary intake (n=18), octreotide acetate (n=8), and ulinastatin (n=8) using an overlapping design. Patients were allocated to either the dietary intake or fasting (no dietary intake) group, and those in the no dietary intake group were further divided into the octreotide acetate or ulinastatin group. Results: Length of hospitalization was longer for the no dietary intake group than for the dietary intake group (p=0.002). When considering only grade B or C POPF cases, the no dietary intake group had a longer length of hospitalization and a higher white blood cell count on day 7 after the diagnosis of POPF than the dietary intake group (p<0.05). The white blood cell count was also higher in the octreotide acetate group than in the ulinastatin group (p=0.021). The length of hospitalization was shorter in the ulinastatin group than in the octreotide acetate group (p=0.025). Conclusions: The use of no dietary intake, octreotide acetate, and ulinastatin do not seem to contribute to the clinical course of patients with POPF after pancreatoduodenectomy.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49449230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.9738/0020-8868-106.1.i
{"title":"Raymond A Dieter, Jr. MD MS","authors":"","doi":"10.9738/0020-8868-106.1.i","DOIUrl":"https://doi.org/10.9738/0020-8868-106.1.i","url":null,"abstract":"","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46233900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.9738/intsurg-d-21-00015.1
H. Lee, Y. Park, Rip Kim, S. Kang, Inn-Chul Nam
Percutaneous dilational tracheostomy (PDT) is a technique that can place a tracheostomy tube safely without visually identifying the trachea. We evaluated its feasibility during head and neck cancer surgery. PDT has many advantages, such as less bleeding, easier technique, and shorter procedural time. Twelve patients who underwent PDT during head and neck cancer surgery from September 2016 to March 2018 were enrolled, and their medical records were reviewed retrospectively. Medical records of another 12 patients who underwent conventional tracheostomy during head and neck cancer surgery were analyzed. PDT was performed using a Ciaglia Percutaneous Tracheostomy Set. The tracheostomy point was determined by palpation without the guidance of bronchoscopy or ultrasonography. Blood loss, procedural time, communication between the cervical wound and tracheostomy wound, and complications were compared between the PDT group and the conventional group. The PDT group had less blood loss, a shorter procedural time, and a lower incidence of communication between the cervical and tracheostomy wound. There was 1 case of conversion to conventional tracheostomy due to wrong tracheal penetration in the PDT group. PDT is safe and effective as an adjunctive procedure during head and neck cancer surgery.
{"title":"Feasibility of Percutaneous Dilatational Tracheotomy in Head and Neck Cancer Surgery: A Preliminary Study","authors":"H. Lee, Y. Park, Rip Kim, S. Kang, Inn-Chul Nam","doi":"10.9738/intsurg-d-21-00015.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-21-00015.1","url":null,"abstract":"\u0000 \u0000 Percutaneous dilational tracheostomy (PDT) is a technique that can place a tracheostomy tube safely without visually identifying the trachea. We evaluated its feasibility during head and neck cancer surgery.\u0000 \u0000 \u0000 \u0000 PDT has many advantages, such as less bleeding, easier technique, and shorter procedural time.\u0000 \u0000 \u0000 \u0000 Twelve patients who underwent PDT during head and neck cancer surgery from September 2016 to March 2018 were enrolled, and their medical records were reviewed retrospectively. Medical records of another 12 patients who underwent conventional tracheostomy during head and neck cancer surgery were analyzed. PDT was performed using a Ciaglia Percutaneous Tracheostomy Set. The tracheostomy point was determined by palpation without the guidance of bronchoscopy or ultrasonography. Blood loss, procedural time, communication between the cervical wound and tracheostomy wound, and complications were compared between the PDT group and the conventional group.\u0000 \u0000 \u0000 \u0000 The PDT group had less blood loss, a shorter procedural time, and a lower incidence of communication between the cervical and tracheostomy wound. There was 1 case of conversion to conventional tracheostomy due to wrong tracheal penetration in the PDT group.\u0000 \u0000 \u0000 \u0000 PDT is safe and effective as an adjunctive procedure during head and neck cancer surgery.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44458734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.9738/intsurg-d-20-00039.1
Gang-Hua Lin, Ta-Wei Pu, Yu-Chun Lin, C. Chang, Yu-Jen Chen, Jung-Cheng Kang, C. Hsiao, Chao-Yang Chen, Je-Ming Hu
Intussusception, although common in the pediatric population, rarely occurs in adults. Furthermore, patients often show nonspecific symptoms. Most adult patients with intussusception have a surgical lead point, a well-defined pathological abnormality, often accurately diagnosed after surgery. A low-grade appendiceal mucinous neoplasm (LAMN), often misdiagnosed as acute appendicitis, is rarely associated with the development of intussusception. Here we report a case of LAMN-related ileocolic intussusception that was histologically diagnosed after laparoscopic right hemicolectomy. A 58-year-old woman visited our emergency department because of intermittent episodes of epigastric pain with periumbilical tenderness. These symptoms persisted intermittently for 2 weeks. The pain was moderate in severity, colicky in nature, and sometimes shifted to the lower abdominal region. Abdominal computed tomography indicated intussusception with ileocecal and mesenteric telescoping into the transverse colon. Complete colonoscopy with reduction of intussusception was performed, revealing a ball-like mass protruding and occupying the entire cecum lumen. Laparoscopic right hemicolectomy was then performed. Macroscopically, a dilated appendix was revealed with mucin content, along with hyalinization and fibrosis of the appendiceal wall. Microscopically, a tumor exhibiting villous and flat proliferation of mucinous epithelial cells with low-grade nuclear atypia was seen. However, there was no infiltration growth of the tumor cells, thereby demonstrating LAMN. Postoperative recovery was uneventful, and the patient was discharged on the 8th postoperative day without surgical complications. The differential diagnoses of chronic and colicky abdominal pain should be expanded to include intussusceptions as they can be severe, although cases in adults are rare.
{"title":"Laparoscopic Right Hemicolectomy of a Low-Grade Appendiceal Mucinous Neoplasm Causing an Ileocolic Intussusception: A Case Report","authors":"Gang-Hua Lin, Ta-Wei Pu, Yu-Chun Lin, C. Chang, Yu-Jen Chen, Jung-Cheng Kang, C. Hsiao, Chao-Yang Chen, Je-Ming Hu","doi":"10.9738/intsurg-d-20-00039.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00039.1","url":null,"abstract":"\u0000 \u0000 Intussusception, although common in the pediatric population, rarely occurs in adults. Furthermore, patients often show nonspecific symptoms. Most adult patients with intussusception have a surgical lead point, a well-defined pathological abnormality, often accurately diagnosed after surgery. A low-grade appendiceal mucinous neoplasm (LAMN), often misdiagnosed as acute appendicitis, is rarely associated with the development of intussusception. Here we report a case of LAMN-related ileocolic intussusception that was histologically diagnosed after laparoscopic right hemicolectomy.\u0000 \u0000 \u0000 \u0000 A 58-year-old woman visited our emergency department because of intermittent episodes of epigastric pain with periumbilical tenderness. These symptoms persisted intermittently for 2 weeks. The pain was moderate in severity, colicky in nature, and sometimes shifted to the lower abdominal region. Abdominal computed tomography indicated intussusception with ileocecal and mesenteric telescoping into the transverse colon. Complete colonoscopy with reduction of intussusception was performed, revealing a ball-like mass protruding and occupying the entire cecum lumen. Laparoscopic right hemicolectomy was then performed. Macroscopically, a dilated appendix was revealed with mucin content, along with hyalinization and fibrosis of the appendiceal wall. Microscopically, a tumor exhibiting villous and flat proliferation of mucinous epithelial cells with low-grade nuclear atypia was seen. However, there was no infiltration growth of the tumor cells, thereby demonstrating LAMN. Postoperative recovery was uneventful, and the patient was discharged on the 8th postoperative day without surgical complications.\u0000 \u0000 \u0000 \u0000 The differential diagnoses of chronic and colicky abdominal pain should be expanded to include intussusceptions as they can be severe, although cases in adults are rare.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42763263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-29DOI: 10.9738/intsurg-d-21-00017.1
Kenji Koneri, T. Goi, M. Shimada, Noriyuki Tagai, Hidetaka Kurebayashi, K. Sawai, M. Morikawa, M. Tamaki, M. Murakami, Y. Hirono, Y. Aoki, O. Yokoyama
Introduction: The Boari flap technique is a unique urinary tract reconstruction procedure performed after resection of the urinary tract. However, few previous reports have described the application of this technique to gastrointestinal cancer. Moreover, we have not found any papers describing the long-term prognosis. We report a case of right ureteral tract resection followed by Boari flap reconstruction for rectosigmoid carcinoma, with survival for 108 months without any urological complications. Case presentation: A woman in her 50s was diagnosed with rectosigmoid caner by local physician and referred to our institution. Computed tomography revealed right hydronephrosis due to rectosigmoid cancer invasion at the lower two-thirds of the right ureter. During laparotomy, massive lymphatic infiltration from the primary lesion to right ureter was observed. After primary tumor resection with lower ureter excision, the Boari flap procedure was performed to reconstruct the ureteral deficit. Postoperative course was uneventful, and she was discharged on postoperative day 20. The patient has been followed every 4 months for 9 years with no recurrence or unpleasant symptoms. Discussion: This technique is usually performed to manage specific conditions such as ureteral stenosis caused by ureteral calculi, retroperitoneal fibrosis, and gynecological disorders. This procedure should be reconsidered as a possible option for gastrointestinal malignant cases instead of nephrostomy or cutaneous ureterostomy, given the low rate of complications and high patient satisfaction. Conclusion: The Boari flap technique is particularly useful for bridging between the ureter and bladder in cases of colorectal malignancy with combined resection of the lower urinary tract.
{"title":"Boari flap urinary tract reconstruction for rectosigmoid cancer with ureteral invasion: Report of a case","authors":"Kenji Koneri, T. Goi, M. Shimada, Noriyuki Tagai, Hidetaka Kurebayashi, K. Sawai, M. Morikawa, M. Tamaki, M. Murakami, Y. Hirono, Y. Aoki, O. Yokoyama","doi":"10.9738/intsurg-d-21-00017.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-21-00017.1","url":null,"abstract":"Introduction: The Boari flap technique is a unique urinary tract reconstruction procedure performed after resection of the urinary tract. However, few previous reports have described the application of this technique to gastrointestinal cancer. Moreover, we have not found any papers describing the long-term prognosis. We report a case of right ureteral tract resection followed by Boari flap reconstruction for rectosigmoid carcinoma, with survival for 108 months without any urological complications. Case presentation: A woman in her 50s was diagnosed with rectosigmoid caner by local physician and referred to our institution. Computed tomography revealed right hydronephrosis due to rectosigmoid cancer invasion at the lower two-thirds of the right ureter. During laparotomy, massive lymphatic infiltration from the primary lesion to right ureter was observed. After primary tumor resection with lower ureter excision, the Boari flap procedure was performed to reconstruct the ureteral deficit. Postoperative course was uneventful, and she was discharged on postoperative day 20. The patient has been followed every 4 months for 9 years with no recurrence or unpleasant symptoms. Discussion: This technique is usually performed to manage specific conditions such as ureteral stenosis caused by ureteral calculi, retroperitoneal fibrosis, and gynecological disorders. This procedure should be reconsidered as a possible option for gastrointestinal malignant cases instead of nephrostomy or cutaneous ureterostomy, given the low rate of complications and high patient satisfaction. Conclusion: The Boari flap technique is particularly useful for bridging between the ureter and bladder in cases of colorectal malignancy with combined resection of the lower urinary tract.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48326270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-11-03DOI: 10.9738/intsurg-d-21-00021.1
Jie Lin, Yong-Xie Jin, Q. Pang
Objective This study intends to explore the diagnostic efficiency and value of PCR in the early diagnosis of periprosthetic joint infection (PJI) based on the testing of the four staphylococcal specific genes ica D, eno, sar A and agr. Methods 41 samples of ultrasonic cleavage RNA eluate were extracted from the human joint model of PJI caused by the five most common PJI pathogens to detect the PCR of ica D, eno, sar A and agr genes. Based on the detection results, the sensitivity, specificity, positive and negative predictive value and accuracy of the four genes were analyzed and compared. Results eno test had a high sensitivity (83.33%). However, more false positive results affected the test specificity (47.06%); sar A test did not show false positive results, but the specificity was high (100%), but the sensitivity was low (41.67%); the sensitivity of ica D and agr test was 4.17% and 0%, respectively, and the clinical value was limited. Conclusion eno and sar A gene detection is of high value in early diagnosis of PJI. Reasonable design and sequential application of eno sensitivity preliminary diagnosis and sar A specific screening of false positive results are more beneficial to the early diagnosis of staphylococcal pathogenic PJI.
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