Pub Date : 2021-01-01DOI: 10.9738/intsurg-d-15-00207.1
S. Yamazoe, R. Amano, K. Kimura, G. Ohira, K. Nishio, Kotaro Miura, Masatsune Shibutani, Katsunobu Sakurai, H. Nagahara, T. Toyokawa, N. Kubo, Hiroaki Tanaka, K. Muguruma, H. Ohtani, M. Yashiro, K. Maeda, Masasichi Ohira, K. Hirakawa
Pancreatic acinar cell carcinoma (ACC) is a relatively rare neoplasm. Furthermore, tumor rupture is extremely rare. Only 1 case of ruptured pancreatic ACC has been reported, and the long-term outcome of the case is unknown. Here, we present a case of spontaneously ruptured ACC with long-term survival after successful resection. A 67-year-old man was brought to our hospital by ambulance, presenting with progressive left abdominal pain. Laboratory data showed an increased inflammatory response, and contrast-enhanced computed tomography showed a mass in the pancreas tail with nonuniform enhancement in the early phase. Fluid collection was detected around the spleen to the left kidney. Spontaneous rupture of a pancreatic tumor was strongly suspected. After improvement of his general condition, the patient underwent resection of the pancreas and adjacent organs. The resected tumor was surrounded by organs and adipose tissue, so obvious exposure was not observed in the surgical margins. Pathologically, neither exposure of tumor cells at the surgical margins nor lymph node involvement was detected. The patient has survived 80 months since initial diagnosis without any evidence of recurrence. Although ruptured pancreatic ACC has the potential for dissemination, surgical resection including adjacent organs remains an option for curative treatment.
{"title":"Spontaneous Rupture of Pancreatic Acinar Cell Carcinoma: Report of a Case","authors":"S. Yamazoe, R. Amano, K. Kimura, G. Ohira, K. Nishio, Kotaro Miura, Masatsune Shibutani, Katsunobu Sakurai, H. Nagahara, T. Toyokawa, N. Kubo, Hiroaki Tanaka, K. Muguruma, H. Ohtani, M. Yashiro, K. Maeda, Masasichi Ohira, K. Hirakawa","doi":"10.9738/intsurg-d-15-00207.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-15-00207.1","url":null,"abstract":"\u0000 \u0000 Pancreatic acinar cell carcinoma (ACC) is a relatively rare neoplasm. Furthermore, tumor rupture is extremely rare. Only 1 case of ruptured pancreatic ACC has been reported, and the long-term outcome of the case is unknown. Here, we present a case of spontaneously ruptured ACC with long-term survival after successful resection.\u0000 \u0000 \u0000 \u0000 A 67-year-old man was brought to our hospital by ambulance, presenting with progressive left abdominal pain. Laboratory data showed an increased inflammatory response, and contrast-enhanced computed tomography showed a mass in the pancreas tail with nonuniform enhancement in the early phase. Fluid collection was detected around the spleen to the left kidney. Spontaneous rupture of a pancreatic tumor was strongly suspected. After improvement of his general condition, the patient underwent resection of the pancreas and adjacent organs. The resected tumor was surrounded by organs and adipose tissue, so obvious exposure was not observed in the surgical margins. Pathologically, neither exposure of tumor cells at the surgical margins nor lymph node involvement was detected. The patient has survived 80 months since initial diagnosis without any evidence of recurrence.\u0000 \u0000 \u0000 \u0000 Although ruptured pancreatic ACC has the potential for dissemination, surgical resection including adjacent organs remains an option for curative treatment.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44647958","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 : 2021-01-01DOI: 10.9738/intsurg-d-15-00157.1
H. Osawa, J. Nishimura, Yoshiyuki Motoki, M. Miyo, Yozo Suzuki, M. Uemura, N. Haraguchi, T. Hata, T. Mizushima, I. Takemasa, Hirofumi Yamamoto, Y. Doki, M. Mori
Paraduodenal hernia is traditionally repaired via conventional laparotomy. Recently, several reports described the repair of paraduodenal hernia via laparoscopic surgery with multiple ports. Due to development of the technique and devices for laparoscopic surgery, single-incision laparoscopic surgery (SILS) has been applied to various operations, including cholecystectomy, appendectomy, and procedures for colorectal cancer. Here, we report treatment of a left paraduodenal hernia via SILS. A 23-year-old man presented with abrupt onset of abdominal pain, nausea, and vomiting. Computed tomography revealed a mass of intestinal loops enveloped by a thin capsule on the left of the abdominal cavity. Blood circulation in the jejunal loops was preserved, and no dilatation of the jejunum was observed. Physical and radiographic examination indicated the possibility of left paraduodenal hernia; we performed paraduodenal hernia repair using SILS. After we confirmed that there was no strangulation or gangrenous change in the bowel on laparoscopic examination, we reduced the incarcerated jejunum loops via an atraumatic method. The postoperative course was uneventful, and the patient was discharged 8 days after the operation. This disease affects relatively young patients, rendering this operation attractive from the viewpoint of cosmetic benefits and minimal invasion. Paraduodenal hernia repair via SILS is feasible, safe, and may constitute an alternative method for paraduodenal hernia without necrotic change.
{"title":"Left Paraduodenal Hernia Treated With Single-Incision Laparoscopic Surgery: Report of a Case","authors":"H. Osawa, J. Nishimura, Yoshiyuki Motoki, M. Miyo, Yozo Suzuki, M. Uemura, N. Haraguchi, T. Hata, T. Mizushima, I. Takemasa, Hirofumi Yamamoto, Y. Doki, M. Mori","doi":"10.9738/intsurg-d-15-00157.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-15-00157.1","url":null,"abstract":"Paraduodenal hernia is traditionally repaired via conventional laparotomy. Recently, several reports described the repair of paraduodenal hernia via laparoscopic surgery with multiple ports. Due to development of the technique and devices for laparoscopic surgery, single-incision laparoscopic surgery (SILS) has been applied to various operations, including cholecystectomy, appendectomy, and procedures for colorectal cancer. Here, we report treatment of a left paraduodenal hernia via SILS. A 23-year-old man presented with abrupt onset of abdominal pain, nausea, and vomiting. Computed tomography revealed a mass of intestinal loops enveloped by a thin capsule on the left of the abdominal cavity. Blood circulation in the jejunal loops was preserved, and no dilatation of the jejunum was observed. Physical and radiographic examination indicated the possibility of left paraduodenal hernia; we performed paraduodenal hernia repair using SILS. After we confirmed that there was no strangulation or gangrenous change in the bowel on laparoscopic examination, we reduced the incarcerated jejunum loops via an atraumatic method. The postoperative course was uneventful, and the patient was discharged 8 days after the operation. This disease affects relatively young patients, rendering this operation attractive from the viewpoint of cosmetic benefits and minimal invasion. Paraduodenal hernia repair via SILS is feasible, safe, and may constitute an alternative method for paraduodenal hernia without necrotic change.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45677230","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 : 2021-01-01DOI: 10.9738/intsurg-d-15-00213.1
T. Shiraishi, N. Tomizawa, Tatsumasa Andoh, Takuhisa Okada, Naoya Ozawa
There are some reports of totally laparoscopic surgery performed by intracorporeal anastomosis without abdominal incision. However, intracorporeal anastomosis with prolapsing technique is difficult and complicated via laparoscopic surgery alone. We found it easier to achieve totally laparoscopic low anterior resection (LAR) by anastomosis anally. Our procedure was performed in 32 patients. After the prolapsed rectum with the tumor was transected, reconstruction was performed by using a double-stapling technique (DST) or a hand-sewn technique (HST). In the DST, the proximal colon was pulled outside transanally, and the anvil head was inserted into the colon and returned to the abdominal cavity. The anal-side rectum was closed using a linear stapling device, and DST was performed. The HST was modified from intersphincteric resection anastomosis. No patient experienced complications associated with this procedure. Cosmetic satisfaction was achieved. All patients obtained disease-free margins pathologically, and none experienced local recurrence. Intracorporeal anastomosis of totally laparoscopic low anterior resection is difficult via laparoscopic ports only. It can be simplified by operating with anastomosis via the anus.
{"title":"Transanal Anastomosis Method and Prolapsing Technique in Totally Laparoscopic Low Anterior Resection for Lower Rectal Cancer","authors":"T. Shiraishi, N. Tomizawa, Tatsumasa Andoh, Takuhisa Okada, Naoya Ozawa","doi":"10.9738/intsurg-d-15-00213.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-15-00213.1","url":null,"abstract":"There are some reports of totally laparoscopic surgery performed by intracorporeal anastomosis without abdominal incision. However, intracorporeal anastomosis with prolapsing technique is difficult and complicated via laparoscopic surgery alone. We found it easier to achieve totally laparoscopic low anterior resection (LAR) by anastomosis anally. Our procedure was performed in 32 patients. After the prolapsed rectum with the tumor was transected, reconstruction was performed by using a double-stapling technique (DST) or a hand-sewn technique (HST). In the DST, the proximal colon was pulled outside transanally, and the anvil head was inserted into the colon and returned to the abdominal cavity. The anal-side rectum was closed using a linear stapling device, and DST was performed. The HST was modified from intersphincteric resection anastomosis. No patient experienced complications associated with this procedure. Cosmetic satisfaction was achieved. All patients obtained disease-free margins pathologically, and none experienced local recurrence. Intracorporeal anastomosis of totally laparoscopic low anterior resection is difficult via laparoscopic ports only. It can be simplified by operating with anastomosis via the anus.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49108945","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 : 2021-01-01DOI: 10.9738/intsurg-d-17-00054.1
Grgur Dulić, Z. Požgain, R. Selthofer, Siniša Bogović, M. Rimac, Borna Kovačić, M. Danilović
Coronary artery bypass grafting in a patient suffering from polycythemia vera is clinically rare and extremely challenging. There is no established protocol regarding the management of these patients because the number of patients in this circumstance is very small. Expressed thrombotic risk in patients suffering from polycythemia vera is highly emphasized in patients with coronary artery disease. Only a few cases have been reported of performing coronary artery bypass grafting, and in those cases a successful outcome seems to be an exception. We report a case of a 73-year-old male caucasian patient suffering from frequent daily chest pain and unstable angina with a 75% stenosis of the left main coronary artery and a subocclusion of proximal right coronary artery undergoing coronary artery bypass grafting, where despite following all the management algorithms and hematologic and cardiologic guidelines properly during the preoperative workup, the patient had a complex postoperative recovery with thrombosis of native coronary vessels—the left anterior descending artery and right coronary artery. Further investigation is needed regarding the effect of deciding between strategies in the domain of cardiac surgery as well as in the hematologic domain on the final outcome. It would be absolutely necessary to conduct a global trial to investigate the preferred cardiosurgical procedure (OPCAB or on-pump CABG).
{"title":"Thrombosis of Coronary Arteries in a Patient With Polycythemia Vera During the Myocardial Revascularization: A Case Report","authors":"Grgur Dulić, Z. Požgain, R. Selthofer, Siniša Bogović, M. Rimac, Borna Kovačić, M. Danilović","doi":"10.9738/intsurg-d-17-00054.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-17-00054.1","url":null,"abstract":"Coronary artery bypass grafting in a patient suffering from polycythemia vera is clinically rare and extremely challenging. There is no established protocol regarding the management of these patients because the number of patients in this circumstance is very small. Expressed thrombotic risk in patients suffering from polycythemia vera is highly emphasized in patients with coronary artery disease. Only a few cases have been reported of performing coronary artery bypass grafting, and in those cases a successful outcome seems to be an exception. We report a case of a 73-year-old male caucasian patient suffering from frequent daily chest pain and unstable angina with a 75% stenosis of the left main coronary artery and a subocclusion of proximal right coronary artery undergoing coronary artery bypass grafting, where despite following all the management algorithms and hematologic and cardiologic guidelines properly during the preoperative workup, the patient had a complex postoperative recovery with thrombosis of native coronary vessels—the left anterior descending artery and right coronary artery. Further investigation is needed regarding the effect of deciding between strategies in the domain of cardiac surgery as well as in the hematologic domain on the final outcome. It would be absolutely necessary to conduct a global trial to investigate the preferred cardiosurgical procedure (OPCAB or on-pump CABG).","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43813914","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 : 2021-01-01DOI: 10.9738/intsurg-d-17-00002.1
M. Elahi, B. Matata
Cardiovascular disease (CVD) in children and adults in least developed countries is on the rise in both urban and rural communities. In the case of sub-Saharan Africa, CVD is now a leading cause of premature deaths, with poor health infrastructure and shortage of skilled cardiac healthcare professionals. There is much discussion among members of the cardiac surgical specialty as to how best to address the latter in such countries. Previously, we have proposed that several actions aimed at implementing humanitarian programs to support nonaffording patients in health systems around the world, would be a forward way. However, the European Association of Cardiothoracic Surgery and its International Committee, on the other hand, does not believe that the best solution is achieved by sending teams to the developing world. Their point of justification is that teamwork is particularly important in cardiac surgery, where the weakest link can determine the ultimate outcomes of surgery. Using this as our starting point, we explored ways of implementing training in local centers partly funded through charitable donations and a public private partnership model. The CardiacEye International Foundation (CEIF; www.cardiaceye.com) team made an exploratory visit to the coastal city of Mombasa in Kenya, to explore contacts with government representatives and health ministers and local hospital doctors and administrators. During this visit, CEIF assessed and examined the levels of local experience and knowledge and the available equipment. A project proposal was put forward aiming to expand scope for provision of cardiac surgery services locally to nonaffording patients through collaborative training of specialists depending on the needs. A cardiovascular surgical team was put together made up of a cardiologist, a surgeon, an anesthetist, a perfusionist, a scrub nurse, an intensive care nurse, a respiratory therapist (or both), and a ward nurse where necessary.
{"title":"To the Editor: Humanitarian Cardiac Surgery Care for Developing Countries: Role in Achieving Sustainable Global Health","authors":"M. Elahi, B. Matata","doi":"10.9738/intsurg-d-17-00002.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-17-00002.1","url":null,"abstract":"Cardiovascular disease (CVD) in children and adults in least developed countries is on the rise in both urban and rural communities. In the case of sub-Saharan Africa, CVD is now a leading cause of premature deaths, with poor health infrastructure and shortage of skilled cardiac healthcare professionals. There is much discussion among members of the cardiac surgical specialty as to how best to address the latter in such countries. Previously, we have proposed that several actions aimed at implementing humanitarian programs to support nonaffording patients in health systems around the world, would be a forward way. However, the European Association of Cardiothoracic Surgery and its International Committee, on the other hand, does not believe that the best solution is achieved by sending teams to the developing world. Their point of justification is that teamwork is particularly important in cardiac surgery, where the weakest link can determine the ultimate outcomes of surgery. Using this as our starting point, we explored ways of implementing training in local centers partly funded through charitable donations and a public private partnership model. The CardiacEye International Foundation (CEIF; www.cardiaceye.com) team made an exploratory visit to the coastal city of Mombasa in Kenya, to explore contacts with government representatives and health ministers and local hospital doctors and administrators. During this visit, CEIF assessed and examined the levels of local experience and knowledge and the available equipment. A project proposal was put forward aiming to expand scope for provision of cardiac surgery services locally to nonaffording patients through collaborative training of specialists depending on the needs. A cardiovascular surgical team was put together made up of a cardiologist, a surgeon, an anesthetist, a perfusionist, a scrub nurse, an intensive care nurse, a respiratory therapist (or both), and a ward nurse where necessary.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71207894","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 : 2021-01-01DOI: 10.9738/intsurg-d-20-00032.1
G. Kutomi, H. Shima, H. Maeda, Fukino Satomi, Asaka Wada, Kiminori Sato, Toru Mizuguchi, I. Takemasa
Axillary dissection is the gold standard for axillary lymph node metastasis in breast cancer patients. We compared surgical outcomes between ultrasonically activated devices (USADs) and thermal scalpel (TS) during axillary lymph node dissection in breast cancer patients. We conducted a retrospective analysis for 73 patients using TS between June 2012 to May 2016 and 63 patients using USADs between June 2016 to January 2019 in the breast cancer patients who received axillary dissection. Surgical outcomes were compared among the groups statistically. Median operative time in the USAD group was significantly shorter than in the TS group (136 versus 182 minutes, P < 0.001). Intraoperative blood loss in the USAD group was also significantly lower than in the TS group (35 versus 120 mL, P < 0.001). Furthermore, the total drainage discharge in the USAD group was also significantly lower than in the TS group (570 versus 700 mL, P = 0.016). The lymphedema frequency in the USAD group was significantly less than in the TS groups (1 of 63 versus 7 of 73, P = 0.0296). The USADs could improve surgical outcomes, such as lymphedema, for axillary dissection of the breast cancer surgery compared with TS.
腋窝清扫是乳腺癌患者腋窝淋巴结转移的金标准。我们比较了超声激活装置(USADs)和热刀(TS)在乳腺癌患者腋窝淋巴结清扫术中的手术效果。我们回顾性分析了2012年6月至2016年5月期间使用TS的73例患者和2016年6月至2019年1月期间使用USADs的63例接受腋窝清扫的乳腺癌患者。对两组手术结果进行统计学比较。USAD组的中位手术时间明显短于TS组(136分钟vs 182分钟，P < 0.001)。USAD组术中出血量也显著低于TS组(35 mL vs 120 mL, P < 0.001)。此外，USAD组的总引流流量也显著低于TS组(570 mL vs 700 mL, P = 0.016)。USAD组淋巴水肿发生率明显低于TS组(63 / 1 vs 73 / 7, P = 0.0296)。与TS相比，USADs可以改善乳腺癌腋窝夹层手术的淋巴水肿等手术效果。
{"title":"Surgical Advantage of Ultrasonically Activated Devices During Axillary Lymph Node Dissection for Breast Cancer","authors":"G. Kutomi, H. Shima, H. Maeda, Fukino Satomi, Asaka Wada, Kiminori Sato, Toru Mizuguchi, I. Takemasa","doi":"10.9738/intsurg-d-20-00032.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00032.1","url":null,"abstract":"\u0000 \u0000 Axillary dissection is the gold standard for axillary lymph node metastasis in breast cancer patients. We compared surgical outcomes between ultrasonically activated devices (USADs) and thermal scalpel (TS) during axillary lymph node dissection in breast cancer patients.\u0000 \u0000 \u0000 \u0000 We conducted a retrospective analysis for 73 patients using TS between June 2012 to May 2016 and 63 patients using USADs between June 2016 to January 2019 in the breast cancer patients who received axillary dissection. Surgical outcomes were compared among the groups statistically.\u0000 \u0000 \u0000 \u0000 Median operative time in the USAD group was significantly shorter than in the TS group (136 versus 182 minutes, P < 0.001). Intraoperative blood loss in the USAD group was also significantly lower than in the TS group (35 versus 120 mL, P < 0.001). Furthermore, the total drainage discharge in the USAD group was also significantly lower than in the TS group (570 versus 700 mL, P = 0.016). The lymphedema frequency in the USAD group was significantly less than in the TS groups (1 of 63 versus 7 of 73, P = 0.0296).\u0000 \u0000 \u0000 \u0000 The USADs could improve surgical outcomes, such as lymphedema, for axillary dissection of the breast cancer surgery compared with TS.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45227447","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}
The aim of this pilot study was to examine the effect of combined target-controlled anesthesia and manually controlled anesthesia on the incidence of postoperative delirium (POD) in patients undergoing spinal surgery. All of the patients were enrolled before spinal surgery and divided into 2 groups at random: one group received combined sevoflurane target-controlled inhalation and sufentanil target-controlled infusion (S-S TCI group), whereas the other received combined manually controlled sevoflurane inhalation and sufentanil infusion (S-S MCI group). Data related to preoperative factors, perioperative factors, and postoperative data were retrospectively collected. Compared with the S-S MCI group, the dosage of vasoactive drugs after surgery, postoperative recovery time, time to cannula removal, and the incidence of POD were significantly decreased in the S-S TCI group (P < 0.05). Overall, POD appeared in 81 patients (16.8%) by postoperative day 3. Multiple regression analysis showed that postoperative blood loss and manually controlled anesthesia were risk factors for POD in spinal surgery patients. Therefore, prophylactic blood transfusion and phenylephrine can reduce the incidence of POD in the presence of postoperative hypotension. Target-controlled anesthesia may improve the quality of anesthesia as well as reduce POD in spinal surgical patients. These results provide clinical evidence for improving the prevention, diagnosis, and management of POD.
{"title":"Target-Controlled Anesthesia Reduces Postoperative Delirium in Spinal Surgical Patients: A Prospective Pilot Study","authors":"Cheng-hua Zhang, Wei-qing Ma, Yun-li Yang, Fa-tuan Dong","doi":"10.9738/intsurg-d-15-00178.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-15-00178.1","url":null,"abstract":"The aim of this pilot study was to examine the effect of combined target-controlled anesthesia and manually controlled anesthesia on the incidence of postoperative delirium (POD) in patients undergoing spinal surgery. All of the patients were enrolled before spinal surgery and divided into 2 groups at random: one group received combined sevoflurane target-controlled inhalation and sufentanil target-controlled infusion (S-S TCI group), whereas the other received combined manually controlled sevoflurane inhalation and sufentanil infusion (S-S MCI group). Data related to preoperative factors, perioperative factors, and postoperative data were retrospectively collected. Compared with the S-S MCI group, the dosage of vasoactive drugs after surgery, postoperative recovery time, time to cannula removal, and the incidence of POD were significantly decreased in the S-S TCI group (P < 0.05). Overall, POD appeared in 81 patients (16.8%) by postoperative day 3. Multiple regression analysis showed that postoperative blood loss and manually controlled anesthesia were risk factors for POD in spinal surgery patients. Therefore, prophylactic blood transfusion and phenylephrine can reduce the incidence of POD in the presence of postoperative hypotension. Target-controlled anesthesia may improve the quality of anesthesia as well as reduce POD in spinal surgical patients. These results provide clinical evidence for improving the prevention, diagnosis, and management of POD.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49425248","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 : 2021-01-01DOI: 10.9738/intsurg-d-15-00165.1
C. Yaşa, O. Dural, I. Demiral, C. Comba, O. Demir, E. Baştu
Torsion of a pedunculated subserous leiomyoma in a pregnant woman is a rare condition that requires prompt diagnosis and urgent surgical intervention. In this report, we present a case of torsion of a pedunculated subserous leiomyoma in a primigravid woman aged 33 years in her 30th week of gestation. A primigravid woman aged 33 years presented to our clinic in her 30th week of gestation with pain in the right lower quadrant that had developed in the last 24 hours. Our diagnosis was torsion of a pedunculated leiomyoma. The patient received a tocolytic of nifedipine and indomethacin preoperatively. Given the volume of the uterus and as a precaution to potential complications, a lower transverse (pfannenstiel) incision was preferred. The laparotomic myomectomy was successfully performed and the pregnancy continued uneventfully. Even though torsion of a pedunculated subserous leiomyoma in pregnancy is a very rare condition, prompt diagnosis and urgent surgical intervention is life saving and provides more favorable maternal and fetal outcomes. The surgical approach should be tailored to the patient and to the characteristics of the myoma and an expert team of surgeons and anesthesiologists is essential in order to reduce the risk of complications.
{"title":"Torsion of a Pedunculated Subserous Leiomyoma in a Pregnant Woman: A Rare Case Report","authors":"C. Yaşa, O. Dural, I. Demiral, C. Comba, O. Demir, E. Baştu","doi":"10.9738/intsurg-d-15-00165.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-15-00165.1","url":null,"abstract":"Torsion of a pedunculated subserous leiomyoma in a pregnant woman is a rare condition that requires prompt diagnosis and urgent surgical intervention. In this report, we present a case of torsion of a pedunculated subserous leiomyoma in a primigravid woman aged 33 years in her 30th week of gestation. A primigravid woman aged 33 years presented to our clinic in her 30th week of gestation with pain in the right lower quadrant that had developed in the last 24 hours. Our diagnosis was torsion of a pedunculated leiomyoma. The patient received a tocolytic of nifedipine and indomethacin preoperatively. Given the volume of the uterus and as a precaution to potential complications, a lower transverse (pfannenstiel) incision was preferred. The laparotomic myomectomy was successfully performed and the pregnancy continued uneventfully. Even though torsion of a pedunculated subserous leiomyoma in pregnancy is a very rare condition, prompt diagnosis and urgent surgical intervention is life saving and provides more favorable maternal and fetal outcomes. The surgical approach should be tailored to the patient and to the characteristics of the myoma and an expert team of surgeons and anesthesiologists is essential in order to reduce the risk of complications.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43518865","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 : 2021-01-01DOI: 10.9738/intsurg-d-20-00027.1
J. Rhu, B. Song, K. Sung, Jinbeom Cho
It can be challenging to perform an appendectomy laparoscopically in patients with complicated appendicitis with severe inflammation or perforation of the appendix base. This study aimed to introduce a simple alternative surgical treatment that can be used safely in difficult appendectomy cases. We retrospectively reviewed the medical records of 14 patients who underwent laparoscopic partial resection of the cecum with a linear stapler between January 2015 and December 2016 in our hospital. Fourteen patients were included in this study, and no surgical complications were observed. Enteral feeding was resumed on the third or fourth postoperative day, and the average length of hospital stay was 7.6 days (range, 5 to 12 days). The results suggest that laparoscopic partial cecal resection with an endostapler is a safe, simple surgical procedure that can be a good alternative in patients with complicated appendicitis.
{"title":"Laparoscopic Partial Cecal Resection With an Endoscopic Linear Stapler in Complicated Appendicitis: A Single Center Experiences","authors":"J. Rhu, B. Song, K. Sung, Jinbeom Cho","doi":"10.9738/intsurg-d-20-00027.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00027.1","url":null,"abstract":"It can be challenging to perform an appendectomy laparoscopically in patients with complicated appendicitis with severe inflammation or perforation of the appendix base. This study aimed to introduce a simple alternative surgical treatment that can be used safely in difficult appendectomy cases. We retrospectively reviewed the medical records of 14 patients who underwent laparoscopic partial resection of the cecum with a linear stapler between January 2015 and December 2016 in our hospital. Fourteen patients were included in this study, and no surgical complications were observed. Enteral feeding was resumed on the third or fourth postoperative day, and the average length of hospital stay was 7.6 days (range, 5 to 12 days). The results suggest that laparoscopic partial cecal resection with an endostapler is a safe, simple surgical procedure that can be a good alternative in patients with complicated appendicitis.","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47031119","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 : 2021-01-01DOI: 10.9738/intsurg-d-20-00042.1
A. Shimada, S. Ishii, Hiroto Tanaka, Tomomi Okamoto, K. Mishima, R. Nakanishi, M. Hosaka, T. Ozaki, K. Igarashi, M. Honda, N. Funamizu, A. Tsutsui, K. Omura, G. Wakabayashi
As the elderly population increases, cases of elderly advanced gastric cancer (AGC) also increase. This study aims to investigate the safety and utility of curative gastrectomy, as well as the efficacy of laparoscopic gastrectomy, for these elderly patients. We retrospectively analyzed the surgical outcomes of patients with cStage IB-III AGC who underwent distal gastrectomy (DG) with D2 lymph node dissection in our institution. We compared the results between elderly patients (>75 years) and non-elderly patients (<75 years). We further divided the elderly patients into 2 groups: those who underwent laparoscopic DG (LDG) and those who underwent open DG (ODG). Further, we compared the results of the 2 groups. From January 2014 to March 2019, 84 patients underwent DG with D2 lymph node dissection for cStage IB-III AGC (52 elderly patients and 32 non-elderly patients). ASA was significantly higher in elderly patients; however, there was no significant difference in surgical outcomes nor in overall survival (OS) and recurrence-free survival (RFS) between the 2 groups. Among 52 elderly patients, 19 had LDG, whereas 33 had ODG. The LDG group had a significantly shorter length of hospital stay and a significantly less amount of blood loss. There was no significant difference in RFS and OS between these 2 groups. Safety and oncologic curability may be achieved in elderly patients with AGC. LDG may be safely performed as ODG in elderly patients with AGC and it is expected to benefit them by achieving minimally invasive surgery.
{"title":"Outcomes of Distal Gastrectomy for Elderly Patients With Advanced Gastric Cancer: Comparison With Non-Elderly Patients and the Utility of Laparoscopic Distal Gastrectomy for Elderly Patients","authors":"A. Shimada, S. Ishii, Hiroto Tanaka, Tomomi Okamoto, K. Mishima, R. Nakanishi, M. Hosaka, T. Ozaki, K. Igarashi, M. Honda, N. Funamizu, A. Tsutsui, K. Omura, G. Wakabayashi","doi":"10.9738/intsurg-d-20-00042.1","DOIUrl":"https://doi.org/10.9738/intsurg-d-20-00042.1","url":null,"abstract":"\u0000 \u0000 As the elderly population increases, cases of elderly advanced gastric cancer (AGC) also increase. This study aims to investigate the safety and utility of curative gastrectomy, as well as the efficacy of laparoscopic gastrectomy, for these elderly patients.\u0000 \u0000 \u0000 \u0000 We retrospectively analyzed the surgical outcomes of patients with cStage IB-III AGC who underwent distal gastrectomy (DG) with D2 lymph node dissection in our institution. We compared the results between elderly patients (>75 years) and non-elderly patients (<75 years). We further divided the elderly patients into 2 groups: those who underwent laparoscopic DG (LDG) and those who underwent open DG (ODG). Further, we compared the results of the 2 groups.\u0000 \u0000 \u0000 \u0000 From January 2014 to March 2019, 84 patients underwent DG with D2 lymph node dissection for cStage IB-III AGC (52 elderly patients and 32 non-elderly patients). ASA was significantly higher in elderly patients; however, there was no significant difference in surgical outcomes nor in overall survival (OS) and recurrence-free survival (RFS) between the 2 groups. Among 52 elderly patients, 19 had LDG, whereas 33 had ODG. The LDG group had a significantly shorter length of hospital stay and a significantly less amount of blood loss. There was no significant difference in RFS and OS between these 2 groups.\u0000 \u0000 \u0000 \u0000 Safety and oncologic curability may be achieved in elderly patients with AGC. LDG may be safely performed as ODG in elderly patients with AGC and it is expected to benefit them by achieving minimally invasive surgery.\u0000","PeriodicalId":14474,"journal":{"name":"International surgery","volume":" ","pages":""},"PeriodicalIF":0.1,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47043128","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}
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