S. Irrinki, Pradeep Kumar, K. Kurdia, Vikas Gupta, B. Mittal, Rajender Kumar, A. Das, Thakur Deen Yadav
Background: The incidence of missed gall bladder cancer (GBC) is increasing with rising numbers of cholecystectomies in North India. Most of these are misrepresented as Incidental gall bladder (IGBC) cancer at referral. Our aim was to analyze the differences in presentation patterns and outcomes of missed GBC and IGBC. Material and methods: A Retrospective analysis of patients referred to as IGBC. Missed GBC were identified as IGBC presenting with any one criteria (Suspicious findings on preoperative ultrasound and/or intraoperative during the Cholecystectomy; Presentation with symptoms or metastasis within one month; pT4 lesion). The outcome of missed GBC was compared to remaining IGBC patients. Results: Sixty-seven patients were included in the study. The median age of presentation was 50 years and the majority were females (83.6%). Index-cholecystectomy was Laparoscopic, open, and lap converted to open in 44.7%,50.7 and 4.4% respectively. The median time to presentation was 30 days (15-720 days). Forty-eight (71.6%) had features of malignancy before index cholecystectomy (ultrasound-21; intraoperative findings-27). Thirty-four (50.7%) had metastatic disease at presentation (Liver-28; peritoneal-23; omental-six). Twenty-one (31.3%) underwent completed extended cholecystectomy (HDR-8; multi-visceral resections-3). Missed GBC had a poorer overall survival over IGBC (16.5Vs 35.3 months P=0.05). Conclusion: Significant proportion of IGBC were missed GBC. This emphasizes the need for careful interpretation of imaging before cholecystectomy in areas endemic to GBC.
{"title":"\"Missed Gall Bladder Cancer During Cholecystectomy - What Price Do We Pay?\" An Experience of a Tertiary Care Center from India","authors":"S. Irrinki, Pradeep Kumar, K. Kurdia, Vikas Gupta, B. Mittal, Rajender Kumar, A. Das, Thakur Deen Yadav","doi":"10.21614/sgo-559","DOIUrl":"https://doi.org/10.21614/sgo-559","url":null,"abstract":"Background: The incidence of missed gall bladder cancer (GBC) is increasing with rising numbers of cholecystectomies in North India. Most of these are misrepresented as Incidental gall bladder (IGBC) cancer at referral. Our aim was to analyze the differences in presentation patterns and outcomes of missed GBC and IGBC. Material and methods: A Retrospective analysis of patients referred to as IGBC. Missed GBC were identified as IGBC presenting with any one criteria (Suspicious findings on preoperative ultrasound and/or intraoperative during the Cholecystectomy; Presentation with symptoms or metastasis within one month; pT4 lesion). The outcome of missed GBC was compared to remaining IGBC patients. Results: Sixty-seven patients were included in the study. The median age of presentation was 50 years and the majority were females (83.6%). Index-cholecystectomy was Laparoscopic, open, and lap converted to open in 44.7%,50.7 and 4.4% respectively. The median time to presentation was 30 days (15-720 days). Forty-eight (71.6%) had features of malignancy before index cholecystectomy (ultrasound-21; intraoperative findings-27). Thirty-four (50.7%) had metastatic disease at presentation (Liver-28; peritoneal-23; omental-six). Twenty-one (31.3%) underwent completed extended cholecystectomy (HDR-8; multi-visceral resections-3). Missed GBC had a poorer overall survival over IGBC (16.5Vs 35.3 months P=0.05). Conclusion: Significant proportion of IGBC were missed GBC. This emphasizes the need for careful interpretation of imaging before cholecystectomy in areas endemic to GBC.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79124940","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}
Pub Date : 2023-01-01DOI: 10.21614/sgo-ec-v.28-a.520
Mohamed Elnemr, Tamer A.A.M. Habeeb, Ibrahim A. Heggy, Tamer Wasefy
Introduction: Lower abdominal pain is caused by various gastrointestinal tract (GIT) emergencies, including acute appendicitis, intestinal obstruction, acute perforated diverticulitis, obstructed hernia, and iatrogenic colon perforation. Therefore, laparoscopy may be of diagnostic and therapeutic value.
{"title":"Retrospective Observational Study of the Role of Laparoscopy in Lower Gastrointestinal Surgical Emergencies in Adults","authors":"Mohamed Elnemr, Tamer A.A.M. Habeeb, Ibrahim A. Heggy, Tamer Wasefy","doi":"10.21614/sgo-ec-v.28-a.520","DOIUrl":"https://doi.org/10.21614/sgo-ec-v.28-a.520","url":null,"abstract":"Introduction: Lower abdominal pain is caused by various gastrointestinal tract (GIT) emergencies, including acute appendicitis, intestinal obstruction, acute perforated diverticulitis, obstructed hernia, and iatrogenic colon perforation. Therefore, laparoscopy may be of diagnostic and therapeutic value.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136207228","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}
Background: One of the most common and dangerous consequences in individuals with decompensated cirrhosis is SBP. Early antibiotic treatment is crucial for effective treatment and lowering death rate. A modulator of the immune response and infection is PGE2. Aim of the Study: To analyze how Prostaglandin E2 and the ascites polymorphic nuclear cell count affect cirrhotic diseased individual mortality prognosis. Material and Methods: Ninety diseased individuals were chosen from the wards of the Internal Medicine Department of Menoufia University Hospitals, the NLI of Menoufia University, and the El Helal Health Insurance Hospital in Shibin Al-Kum for this prospective diagnostic test study. Two cohorts of participants were formed. Cohort I: 45 diseased individuals with hepatic cirrhosis and SBP, as well as 45 diseased individuals without SBP. All diseased individuals had a history review, MELD and CTP scores, a pelvic-abdominal ultrasound, and laboratory investigations such as serum, CBC with differentials made by CRP and ESR, INR and prothrombin time, SAAG, serum creatinine and urea, and liver function tests (ALT and AST), GGT, and Alk.pho. PMN and serum ascitic fluid prostaglandin E2 are included in ascitic fluid analyses. Results: While ascitic fluid PGE2 was elevated in the non-SBP cohort, PMN cell count was elevated in the SBP cohort. Regarding ascitic fluid PGE2, there is a substantial difference between the two cohorts. There are numerous advantages. The relationship between PMN cells and other factors, including ascitic fluid PGE2, Hb, WBC, GGT, alkalinity, and MELD score. The relationship between ascitic fluid PGE2 and other WBC is significantly inverse. Conclusion: both blood and ascitic fluid for the detection and eradication of SBP, as well as for predicting death in cirrhotic diseased individuals, PGDE2 and PMN can be employed as diagnostic and prognostic markers
{"title":"Role of Ascitic Fluid Polymorphic Nuclear Cell Count and Prostaglandin E2 Prognostic Outcome of Cirrhotic Diseased Individual's Mortality","authors":"Abdel-Naser Abdel-Atty Gad Allah, Radwa Essam Abbas, Ashraf Ghareib Dala, Shaimaa Elsayed Ramadan, Hany Abdelbary AbdelAziz","doi":"10.21614/sgo-514","DOIUrl":"https://doi.org/10.21614/sgo-514","url":null,"abstract":"Background: One of the most common and dangerous consequences in individuals with decompensated cirrhosis is SBP. Early antibiotic treatment is crucial for effective treatment and lowering death rate. A modulator of the immune response and infection is PGE2. Aim of the Study: To analyze how Prostaglandin E2 and the ascites polymorphic nuclear cell count affect cirrhotic diseased individual mortality prognosis. Material and Methods: Ninety diseased individuals were chosen from the wards of the Internal Medicine Department of Menoufia University Hospitals, the NLI of Menoufia University, and the El Helal Health Insurance Hospital in Shibin Al-Kum for this prospective diagnostic test study. Two cohorts of participants were formed. Cohort I: 45 diseased individuals with hepatic cirrhosis and SBP, as well as 45 diseased individuals without SBP. All diseased individuals had a history review, MELD and CTP scores, a pelvic-abdominal ultrasound, and laboratory investigations such as serum, CBC with differentials made by CRP and ESR, INR and prothrombin time, SAAG, serum creatinine and urea, and liver function tests (ALT and AST), GGT, and Alk.pho. PMN and serum ascitic fluid prostaglandin E2 are included in ascitic fluid analyses. Results: While ascitic fluid PGE2 was elevated in the non-SBP cohort, PMN cell count was elevated in the SBP cohort. Regarding ascitic fluid PGE2, there is a substantial difference between the two cohorts. There are numerous advantages. The relationship between PMN cells and other factors, including ascitic fluid PGE2, Hb, WBC, GGT, alkalinity, and MELD score. The relationship between ascitic fluid PGE2 and other WBC is significantly inverse. Conclusion: both blood and ascitic fluid for the detection and eradication of SBP, as well as for predicting death in cirrhotic diseased individuals, PGDE2 and PMN can be employed as diagnostic and prognostic markers","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85907385","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}
Nikolaos Bogiatzopoulos, N. Rodis, Loredana Tanaseskou, C. Seretis, Maria Tsimara, G. Zacharis
Abdominal drains are frequently used in both elective and emergency laparotomies, in order to prevent formation of postoperative collections in gravity-dependent positions or as means of early detection of postoperative hemorrhage and anastomotic leaks. Despite the benefits of their use, rare drain-related complications have been reported in the literature, including adhesional
{"title":"Early Postoperative Small Bowel Obstruction: Can We Blame the Drain?","authors":"Nikolaos Bogiatzopoulos, N. Rodis, Loredana Tanaseskou, C. Seretis, Maria Tsimara, G. Zacharis","doi":"10.21614/sgo-554","DOIUrl":"https://doi.org/10.21614/sgo-554","url":null,"abstract":"Abdominal drains are frequently used in both elective and emergency laparotomies, in order to prevent formation of postoperative collections in gravity-dependent positions or as means of early detection of postoperative hemorrhage and anastomotic leaks. Despite the benefits of their use, rare drain-related complications have been reported in the literature, including adhesional","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86351494","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}
Durr-e-Nayab Masood, Mark Tacey, Neil Strugnell, Russell Hodgson
Objective: Patients with acute diverticulitis (AD) have an increased risk of underlying colorectal cancer (CRC), however those with uncomplicated AD may have the same underlying population risk. Despite evidence suggesting these patients may not require further endoscopy, published guidelines still recommended Colonoscopy as standard post-diverticulitis management. A practical approach to the definition of bowel wall thickening may improve negative predictability, a potential impediment to omitting colonoscopic followup.
{"title":"Practical Decision-Making in Regards to Colonoscopy following Admission for Acute Diverticulitis","authors":"Durr-e-Nayab Masood, Mark Tacey, Neil Strugnell, Russell Hodgson","doi":"10.21614/sgo-595","DOIUrl":"https://doi.org/10.21614/sgo-595","url":null,"abstract":"Objective: Patients with acute diverticulitis (AD) have an increased risk of underlying colorectal cancer (CRC), however those with uncomplicated AD may have the same underlying population risk. Despite evidence suggesting these patients may not require further endoscopy, published guidelines still recommended Colonoscopy as standard post-diverticulitis management. A practical approach to the definition of bowel wall thickening may improve negative predictability, a potential impediment to omitting colonoscopic followup.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136207240","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}
Dumitru Casian, Alexandru Predenciuc, Vasile Culiuc, Joakim Nordanstig, Mark B.F. Morgan
Background: Patient reported outcomes are valuable components in the assessment of results of treatment for peripheral arterial disease (PAD). The aim of the study was to translate the six item Vascular Quality of Life Questionnaire (VascuQoL-6) survey into Romanian, and to validate the psychometric performance of the questionnaire in a representative cohort of patients with lower extremity arterial disease.
{"title":"Romanian Translation and Validation of Vascular Quality of Life Questionnaire \"VascuQOL-6\" in Patients with Lower Extremity Arterial Disease","authors":"Dumitru Casian, Alexandru Predenciuc, Vasile Culiuc, Joakim Nordanstig, Mark B.F. Morgan","doi":"10.21614/sgo-592","DOIUrl":"https://doi.org/10.21614/sgo-592","url":null,"abstract":"Background: Patient reported outcomes are valuable components in the assessment of results of treatment for peripheral arterial disease (PAD). The aim of the study was to translate the six item Vascular Quality of Life Questionnaire (VascuQoL-6) survey into Romanian, and to validate the psychometric performance of the questionnaire in a representative cohort of patients with lower extremity arterial disease.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136207242","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. Shehta, Ahmed Farouk, M. Elashry, Ibrahim L. Abulazm, Mohamed M. El-Sorogy, A. Monier
Purpose: To evaluate the incidence and the different potential risk factors for the development of anastomotic leakage (AL) after resection of left-sided colon cancer. Also, to evaluate the AL impact on long-term survival outcomes. Methods: We reviewed the cases who underwent surgical resection of left-sided colon cancer during the period between January 2008 and December 2018. Results: 218 cases were included in our study. The commonest presentations were weight loss (45.9%), and bleeding per rectum (40.8%). Left hemi-colectomy was performed in 101 cases (46.3%) and sigmoidectomy in 117 cases (53.7%). The median operation time was 3 hours (1 – 5), and blood loss was 150 ml (50 – 750). Postoperative morbidity occurred in 28 cases (22.1%). AL occurred in 12 cases (5.5%). Early mortality occurred in 6 cases (2.8%). After median follow up of 38 months (15 – 120), mortality occurred in 44 cases (20.2%). The 1, 3-, and 5-years overall survival (OS) were 98.8%, 84.4%, and 64.4%, respectively. Recurrence occurred in 91 cases (41.7%). The 1, 3-, and 5-years disease-free survival (DFS) were 94.9%, 49.1%, and 38%, respectively. We did not find any significant differences between cases with and without AL in terms of OS (p = 0.634) and DFS (p = 0.682). On multivariate analysis, only preoperative serum CEA and operative blood loss were significant predictors for AL. Conclusion: Preoperative serum CEA and operative blood loss were significant predictors for AL. AL did not have a significant impact on the survival outcomes of those cases.
{"title":"Predictive Factors of Anastomotic Leakage after Resection of Left Colon Cancer: A Single Center Experience","authors":"A. Shehta, Ahmed Farouk, M. Elashry, Ibrahim L. Abulazm, Mohamed M. El-Sorogy, A. Monier","doi":"10.21614/sgo-542","DOIUrl":"https://doi.org/10.21614/sgo-542","url":null,"abstract":"Purpose: To evaluate the incidence and the different potential risk factors for the development of anastomotic leakage (AL) after resection of left-sided colon cancer. Also, to evaluate the AL impact on long-term survival outcomes. Methods: We reviewed the cases who underwent surgical resection of left-sided colon cancer during the period between January 2008 and December 2018. Results: 218 cases were included in our study. The commonest presentations were weight loss (45.9%), and bleeding per rectum (40.8%). Left hemi-colectomy was performed in 101 cases (46.3%) and sigmoidectomy in 117 cases (53.7%). The median operation time was 3 hours (1 – 5), and blood loss was 150 ml (50 – 750). Postoperative morbidity occurred in 28 cases (22.1%). AL occurred in 12 cases (5.5%). Early mortality occurred in 6 cases (2.8%). After median follow up of 38 months (15 – 120), mortality occurred in 44 cases (20.2%). The 1, 3-, and 5-years overall survival (OS) were 98.8%, 84.4%, and 64.4%, respectively. Recurrence occurred in 91 cases (41.7%). The 1, 3-, and 5-years disease-free survival (DFS) were 94.9%, 49.1%, and 38%, respectively. We did not find any significant differences between cases with and without AL in terms of OS (p = 0.634) and DFS (p = 0.682). On multivariate analysis, only preoperative serum CEA and operative blood loss were significant predictors for AL. Conclusion: Preoperative serum CEA and operative blood loss were significant predictors for AL. AL did not have a significant impact on the survival outcomes of those cases.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73785421","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}
S. I. Karmane, Hui Cheng Vai, Kok Lai Fong, Chio Chan Fong, Chong Keng Sang, J. Costa-Maia
Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially lethal complication. Despite various treatment modalities with curative intent, there are scant data on ruptured cases achieving complete pathological response (pCR), with only a handful of case reports. We report a case of a Chinese male patient with large advanced HCC (aHCC) first detected with rupture in an emergency setting, developing a pCR after multidisciplinary onco-surgical approach.
{"title":"Complete Pathological Response in Advanced Hepatocellular Carcinoma. Peek-A-Boo?","authors":"S. I. Karmane, Hui Cheng Vai, Kok Lai Fong, Chio Chan Fong, Chong Keng Sang, J. Costa-Maia","doi":"10.21614/sgo-533","DOIUrl":"https://doi.org/10.21614/sgo-533","url":null,"abstract":"Spontaneous rupture of hepatocellular carcinoma (HCC) is a potentially lethal complication. Despite various treatment modalities with curative intent, there are scant data on ruptured cases achieving complete pathological response (pCR), with only a handful of case reports. We report a case of a Chinese male patient with large advanced HCC (aHCC) first detected with rupture in an emergency setting, developing a pCR after multidisciplinary onco-surgical approach.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89690053","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}
Pub Date : 2023-01-01DOI: 10.21614/sgo-ec-v.28-a.519
Walid A. Mawla, A A M Habeeb Tamer, Elaidy Mostafa.M., Alaaedin Ramadan
Introduction: Laparoscopy can diagnose and treat the etiologies of acute upper abdominal pain. This study aimed to assess the effectiveness of laparoscopy in upper gastrointestinal (G.I.T) emergencies regarding intraoperative and postoperative outcomes.
{"title":"The Role of Laparoscopy in Upper Abdominal Surgical Emergencies in Adults: A Retrospective Observational Study","authors":"Walid A. Mawla, A A M Habeeb Tamer, Elaidy Mostafa.M., Alaaedin Ramadan","doi":"10.21614/sgo-ec-v.28-a.519","DOIUrl":"https://doi.org/10.21614/sgo-ec-v.28-a.519","url":null,"abstract":"Introduction: Laparoscopy can diagnose and treat the etiologies of acute upper abdominal pain. This study aimed to assess the effectiveness of laparoscopy in upper gastrointestinal (G.I.T) emergencies regarding intraoperative and postoperative outcomes.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136207226","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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