C. Papageorgopoulou, K. Nikolakopoulos, C. Seretis
Undescended cecum is a rare congenital abnormality; upon development of acute appendicitis though, the high position of the cecum results in atypical clinical symptomatology. We present a rare case of appendicitis in a patient with undescended cecum, which we managed laparoscopically, combining the appendicectomy with orthotopic repositioning of the cecum.
{"title":"Acute Appendicitis in the Context of Undescended Cecum: Laparoscopic Management with Restoration of the Orthotopic Anatomy","authors":"C. Papageorgopoulou, K. Nikolakopoulos, C. Seretis","doi":"10.21614/sgo-472","DOIUrl":"https://doi.org/10.21614/sgo-472","url":null,"abstract":"Undescended cecum is a rare congenital abnormality; upon development of acute appendicitis though, the high position of the cecum results in atypical clinical symptomatology. We present a rare case of appendicitis in a patient with undescended cecum, which we managed laparoscopically, combining the appendicectomy with orthotopic repositioning of the cecum.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86501895","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}
T. Fonseca, João Miranda, Vítor Devezas, Marisa Aral, Rui Mendes Costa, J. Costa Maia
Background/Objectives: Acute pancreatitis (AP) is a common cause of hospitalization and severe cases are usually associated with a poor prognosis. Neutrophil to lymphocyte ratio(NLR) has been pointed as an indicator of systemic inflammation in several disorders. The aim of this study was to assess whether NLR at admission is able to predict severity of AP and some associated outcomes, while trying to establish the best cut-off value for
{"title":"A Closer Look: Assessment of Acute Pancreatitis Prognosis Using Neutrophil-Lymphocyte Ratio","authors":"T. Fonseca, João Miranda, Vítor Devezas, Marisa Aral, Rui Mendes Costa, J. Costa Maia","doi":"10.21614/sgo-26-2-296","DOIUrl":"https://doi.org/10.21614/sgo-26-2-296","url":null,"abstract":"Background/Objectives: Acute pancreatitis (AP) is a common cause of hospitalization and severe cases are usually associated with a poor prognosis. Neutrophil to lymphocyte ratio(NLR) has been pointed as an indicator of systemic inflammation in several disorders. The aim of this study was to assess whether NLR at admission is able to predict severity of AP and some associated outcomes, while trying to establish the best cut-off value for","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"154 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73454987","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}
Mirela Patricia Sîrbu Boeți, Andrei Marius Baicu, M. Toma, V. Herlea, L. Iliescu
Introduction: Cirrhotic patients are difficult patients to operate on and are generally considered unsuitable for laparoscopy (1,2). We present the clinical case of a cirrhotic patient with comorbidities that was diagnosed with a hepatic nodule and cortisol secreting right adrenal tumor, for which a multidisciplinary team decided to submit him for laparoscopic intervention. Case report: N.D. is a 59 y.o. male, diagnosed in 2010 with alcoholic Child-Pugh B liver cirrhosis (score 9). In February 2019, a hepatic nodule in segment IV-A (2 cm) and cortisol secreting right adrenal tumor (6/4/4 cm) were found. He is also diagnosed with essential arterial hypertension grade II, mild diastolic dysfunction of the left ventricle, aortic sclerosis, chronic ischemic cardiomyopathy, type 2 diabetes mellitus and chronic gastritis. He had laparoscopic cholecystectomy in 2000. The hepatic nodule in segment IV-A was highly suggestive of hepatocellular carcinoma due to imaging characteristics. Subclinical secretion of cortisol was present (low ACTH 4.18 pg/ml, normal plasmatic cortisol, metanephrine, normetanephrine). AFP, CEA, CA 19-9 were normal. The patient underwent surgery on 27 May 2019. Adhesiolysis, transperitoneal laparoscopic right adrenalectomy and alcoholization of hepatic tumor have been performed. Radiofrequency ablation of the hepatic tumor was preoperatively anticipated but was intraoperatively abandoned in favor of in situ hepatic tumor ablation with percutaneous ethanol injection due to encountered metabolic acidosis and cardiac arrhythmia. Results: Postoperatively the patient developed hemorrhagic ascites and abdominal wall hematoma that were successfully controlled by conservative measurements. He was discharged on the 15 th postoperative day. Histopathology found cortical-adrenal adenoma with clear cells. The patient was completely withdrawn from corticosteroids in October 2019. On October 1st, 2019, transarterial chemoembolization (TACE) with Gelaspon, Lipidol and Doxorubicin was performed to completely ablate the hepatic nodule. After two years the patient had Child-Pugh B cirrhosis (score 7) with no tumor recurrence. Conclusion: Laparoscopic right adrenalectomy could be safely performed for a right adrenal tumor in a Child-Pugh B cirrhotic patient with other comorbidities but the percutaneous alcoholization of the hepatic nodule under video and ultrasound guidance needed TACE for its complete destruction.
{"title":"Laparoscopic Right Adrenalectomy for a Large Adrenal Tumor Combined with in situ Ablation of a Hepatic Nodule in a Cirrhotic Patient","authors":"Mirela Patricia Sîrbu Boeți, Andrei Marius Baicu, M. Toma, V. Herlea, L. Iliescu","doi":"10.21614/sgo-26-2-362","DOIUrl":"https://doi.org/10.21614/sgo-26-2-362","url":null,"abstract":"Introduction: Cirrhotic patients are difficult patients to operate on and are generally considered unsuitable for laparoscopy (1,2). We present the clinical case of a cirrhotic patient with comorbidities that was diagnosed with a hepatic nodule and cortisol secreting right adrenal tumor, for which a multidisciplinary team decided to submit him for laparoscopic intervention. Case report: N.D. is a 59 y.o. male, diagnosed in 2010 with alcoholic Child-Pugh B liver cirrhosis (score 9). In February 2019, a hepatic nodule in segment IV-A (2 cm) and cortisol secreting right adrenal tumor (6/4/4 cm) were found. He is also diagnosed with essential arterial hypertension grade II, mild diastolic dysfunction of the left ventricle, aortic sclerosis, chronic ischemic cardiomyopathy, type 2 diabetes mellitus and chronic gastritis. He had laparoscopic cholecystectomy in 2000. The hepatic nodule in segment IV-A was highly suggestive of hepatocellular carcinoma due to imaging characteristics. Subclinical secretion of cortisol was present (low ACTH 4.18 pg/ml, normal plasmatic cortisol, metanephrine, normetanephrine). AFP, CEA, CA 19-9 were normal. The patient underwent surgery on 27 May 2019. Adhesiolysis, transperitoneal laparoscopic right adrenalectomy and alcoholization of hepatic tumor have been performed. Radiofrequency ablation of the hepatic tumor was preoperatively anticipated but was intraoperatively abandoned in favor of in situ hepatic tumor ablation with percutaneous ethanol injection due to encountered metabolic acidosis and cardiac arrhythmia. Results: Postoperatively the patient developed hemorrhagic ascites and abdominal wall hematoma that were successfully controlled by conservative measurements. He was discharged on the 15 th postoperative day. Histopathology found cortical-adrenal adenoma with clear cells. The patient was completely withdrawn from corticosteroids in October 2019. On October 1st, 2019, transarterial chemoembolization (TACE) with Gelaspon, Lipidol and Doxorubicin was performed to completely ablate the hepatic nodule. After two years the patient had Child-Pugh B cirrhosis (score 7) with no tumor recurrence. Conclusion: Laparoscopic right adrenalectomy could be safely performed for a right adrenal tumor in a Child-Pugh B cirrhotic patient with other comorbidities but the percutaneous alcoholization of the hepatic nodule under video and ultrasound guidance needed TACE for its complete destruction.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"7 11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86650450","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}
C. Picu, F. Botea, D. Hrehoreţ, S. Alexandrescu, R. Grigorie, V. Brașoveanu
We present a case of a 63-year-old male with HCC developed on viral cirrhosis (HVB-HVD) Child C, MELD 15 who was performed a cadaveric orthotopic liver transplantation (marginal graft previous perfused and oxygenated using the Liver Assist Device). After one month, in the context of a febrile episode, the patient was discovered a biliary stenosis associated with biliary fistulae for which he was placed a biliary stent (ERCP). The afterwards abdominal CT revealed absence of the visualization of the graft common hepatic artery and its intrahepatic branches. An arteriography in an emergency manner was performed, with administration of Actylise, and then continued with Ilomedin and Heparin administration, but with no improved imaging appearance. The patient underwent a liver retransplantation - the arterial anastomose was performed between the donor superior mesenteric artery (due to the anatomical variant: accessory right hepatic artery from superior mesenteric artery) and the recipient infrarenal aorta (using iliac cadaveric arterial graft). 18 months after the retransplantation, the CT scan revealed homogeneous hepatic graft and permeable vascular axis.
{"title":"Hepatic Artery Thrombosis in Liver Transplantation - Case Report and Literature Review","authors":"C. Picu, F. Botea, D. Hrehoreţ, S. Alexandrescu, R. Grigorie, V. Brașoveanu","doi":"10.21614/sgo-26-2-356","DOIUrl":"https://doi.org/10.21614/sgo-26-2-356","url":null,"abstract":"We present a case of a 63-year-old male with HCC developed on viral cirrhosis (HVB-HVD) Child C, MELD 15 who was performed a cadaveric orthotopic liver transplantation (marginal graft previous perfused and oxygenated using the Liver Assist Device). After one month, in the context of a febrile episode, the patient was discovered a biliary stenosis associated with biliary fistulae for which he was placed a biliary stent (ERCP). The afterwards abdominal CT revealed absence of the visualization of the graft common hepatic artery and its intrahepatic branches. An arteriography in an emergency manner was performed, with administration of Actylise, and then continued with Ilomedin and Heparin administration, but with no improved imaging appearance. The patient underwent a liver retransplantation - the arterial anastomose was performed between the donor superior mesenteric artery (due to the anatomical variant: accessory right hepatic artery from superior mesenteric artery) and the recipient infrarenal aorta (using iliac cadaveric arterial graft). 18 months after the retransplantation, the CT scan revealed homogeneous hepatic graft and permeable vascular axis.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74954269","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. Taha, Ramy A. Hassan, M. Mahdy, M. S. Abbas, N. Makhlouf, S. Hassaneen, Tameem M. Ibraheem
Background: We describe our experience with two techniques of bile duct division in donors of right lobe living donor liver transplantation (RL-LDLT). Methods: 49 RL-LDLT done in Al-Rajhi Liver Hospital, Assiut University, Egypt were divided into 2 eras; from November 2014 till September 2018, the site of biliary division in 29 donors was marked by metal clips (Clips group) and from October 2018 till September 2019, 20 donors were marked by radio-opaque filaments (ROF group). Results: There were no differences between groups in donors’ and recipients’ baseline characteristics. In ROF group there were less number of bile ducts stumps (2, range 1-3 versus 2 range 1-4 in Clips group, p=0.044), less number of “imprecise-transection” (1 (5%) versus 11 (37.9%) in Clips group, p=0.009) and fewer number intraoperative cholangiographies performed (1, range 1-2 versus 2 range 1-3 in Clips group, p=0.001). There were no differences between groups in the number of biliary anastomoses or incidence of biliary complications in donors or recipients. Median follow up is 33 months (range 8-66). Conclusions: Marking biliary division by ROF is a simple and minor modification but can decrease the difficulty of surgery and reduce exposure of donor and operating team to
{"title":"Radio-Opaque Filaments Guided Bile Duct Division During Living Donor Liver Transplantation, a Simple Solution to an Ongoing Dilemma","authors":"A. Taha, Ramy A. Hassan, M. Mahdy, M. S. Abbas, N. Makhlouf, S. Hassaneen, Tameem M. Ibraheem","doi":"10.21614/sgo-26-2-259","DOIUrl":"https://doi.org/10.21614/sgo-26-2-259","url":null,"abstract":"Background: We describe our experience with two techniques of bile duct division in donors of right lobe living donor liver transplantation (RL-LDLT). Methods: 49 RL-LDLT done in Al-Rajhi Liver Hospital, Assiut University, Egypt were divided into 2 eras; from November 2014 till September 2018, the site of biliary division in 29 donors was marked by metal clips (Clips group) and from October 2018 till September 2019, 20 donors were marked by radio-opaque filaments (ROF group). Results: There were no differences between groups in donors’ and recipients’ baseline characteristics. In ROF group there were less number of bile ducts stumps (2, range 1-3 versus 2 range 1-4 in Clips group, p=0.044), less number of “imprecise-transection” (1 (5%) versus 11 (37.9%) in Clips group, p=0.009) and fewer number intraoperative cholangiographies performed (1, range 1-2 versus 2 range 1-3 in Clips group, p=0.001). There were no differences between groups in the number of biliary anastomoses or incidence of biliary complications in donors or recipients. Median follow up is 33 months (range 8-66). Conclusions: Marking biliary division by ROF is a simple and minor modification but can decrease the difficulty of surgery and reduce exposure of donor and operating team to","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85197083","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. Iacob, M. Onica, R. Iacob, C. Gheorghe, S. Beckebaum, V. Cicinnati, I. Popescu, L. Gheorghe
Background: Long-term morbidity and mortality following liver transplantation (LT) is influenced by HCV-related extrahepatic complications and effects of immunosuppressive therapy. Aim: To investigate if sustained virological response (SVR) after therapy with direct acting antivirals (DAA) in recipients with post-transplant recurrent hepatitis C can influence metabolic factors and renal function. Methods: Metabolic profile, cardiovascular risk scores, non-invasive evaluation of fibrosis, renal function was assessed in 89 HCV LT recipients at SVR and 24 months after cure. Results: Liver stiffness measurement evaluated by transient elastography, APRI, FIB-4 and NAFLD fibrosis scores decreased significantly between baseline, SVR and 24 months after SVR. In contrast, BARD score increased significantly (p=0.001). Steatosis grade 3 was significantly encountered in a higher percentage at 24 months after SVR compared to baseline (77.5% vs 22.5%, p<0.0001). The metabolic and cardiovascular risk profile (MetS and Framingham scores), respectively, remained stable during the timeline. All liver function tests such as alanine and aspartate aminotransferase, gamma glutamyl transferase, total bilirubin improved between initiation of antivirals, SVR and 24 months after SVR; platelets increased significantly (p<0.0001 for each variable). The renal function evaluated by creatinine serum level (p=0.03) and estimated glomerular filtration rate (p=0.02) was significantly deteriorated over time. Conclusions: Eradication of recurrent HCV infection has a clear benefit for liver-related complications, but has no impact on HCV extrahepatic manifestations. Prospective studies with non-HCV cohorts are required to compare the impact of immunosuppression on metabolic and renal complications.
背景:肝移植(LT)术后的长期发病率和死亡率受到hcv相关肝外并发症和免疫抑制治疗效果的影响。目的:探讨丙型肝炎移植后复发患者接受直接抗病毒药物(DAA)治疗后的持续病毒学反应(SVR)是否会影响代谢因子和肾功能。方法:在SVR和治愈后24个月对89例HCV肝移植患者的代谢特征、心血管风险评分、无创纤维化评估和肾功能进行评估。结果:通过瞬时弹性图、APRI、FIB-4和NAFLD纤维化评分评估的肝脏硬度测量在基线、SVR和SVR后24个月之间显著下降。相比之下，BARD评分显著升高(p=0.001)。与基线相比，SVR后24个月出现3级脂肪变性的比例明显更高(77.5% vs 22.5%， p<0.0001)。代谢和心血管风险概况(MetS和Framingham评分)分别在时间轴上保持稳定。所有肝功能测试，如丙氨酸和天冬氨酸转氨酶、谷氨酰转移酶、总胆红素在开始抗病毒药物、SVR和SVR后24个月期间改善;血小板显著增加(各变量p<0.0001)。血清肌酐水平(p=0.03)和肾小球滤过率(p=0.02)评估的肾功能随着时间的推移而显著恶化。结论:根除复发性HCV感染对肝脏相关并发症有明显的益处，但对HCV肝外表现没有影响。需要对非hcv队列进行前瞻性研究，以比较免疫抑制对代谢和肾脏并发症的影响。
{"title":"Impact of Sustained Virological Response on Metabolic Profile and Kidney Function in Cured HCV Liver Transplant Recipients","authors":"S. Iacob, M. Onica, R. Iacob, C. Gheorghe, S. Beckebaum, V. Cicinnati, I. Popescu, L. Gheorghe","doi":"10.21614/sgo-26-2-364","DOIUrl":"https://doi.org/10.21614/sgo-26-2-364","url":null,"abstract":"Background: Long-term morbidity and mortality following liver transplantation (LT) is influenced by HCV-related extrahepatic complications and effects of immunosuppressive therapy. Aim: To investigate if sustained virological response (SVR) after therapy with direct acting antivirals (DAA) in recipients with post-transplant recurrent hepatitis C can influence metabolic factors and renal function. Methods: Metabolic profile, cardiovascular risk scores, non-invasive evaluation of fibrosis, renal function was assessed in 89 HCV LT recipients at SVR and 24 months after cure. Results: Liver stiffness measurement evaluated by transient elastography, APRI, FIB-4 and NAFLD fibrosis scores decreased significantly between baseline, SVR and 24 months after SVR. In contrast, BARD score increased significantly (p=0.001). Steatosis grade 3 was significantly encountered in a higher percentage at 24 months after SVR compared to baseline (77.5% vs 22.5%, p<0.0001). The metabolic and cardiovascular risk profile (MetS and Framingham scores), respectively, remained stable during the timeline. All liver function tests such as alanine and aspartate aminotransferase, gamma glutamyl transferase, total bilirubin improved between initiation of antivirals, SVR and 24 months after SVR; platelets increased significantly (p<0.0001 for each variable). The renal function evaluated by creatinine serum level (p=0.03) and estimated glomerular filtration rate (p=0.02) was significantly deteriorated over time. Conclusions: Eradication of recurrent HCV infection has a clear benefit for liver-related complications, but has no impact on HCV extrahepatic manifestations. Prospective studies with non-HCV cohorts are required to compare the impact of immunosuppression on metabolic and renal complications.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"38 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72374693","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}
Ryosuke Umino, J. Shindoh, Yuta Kobayashi, Miho Akabane, Kazutaka Kojima, S. Okubo, M. Hashimoto
Background: Various nutritional/inflammatory scores reportedly correlate with surgical outcomes of abdominal surgery, while it remains inconclusive which one is the best in prediction of short-term surgical outcomes of patients with colorectal liver metastasis (CLM). Methods: Clinical records of 367 hepatectomies for 267 patients with CLM were retrospectively reviewed. Preoperative nutritional/inflammatory status was determined using 14 reported nutritional/inflammatory scores and predictive powers of these scores for short-term surgical outcomes were compared. Results: In receiver operating characteristics curve analysis, controlling nutritional status (CONUT) score showed the highest performance in prediction of major postoperative morbidity (area under the curve [AUC], 0.650) among the tested scores and similar tendency was also confirmed in prediction of global postoperative morbidity (AUC, 0.622). Multivariate analysis confirmed that the CONUT score showed significant correlation with both global morbidity (odds ratio [OR], 1.29; 95% CI, 1.11-1.49, P=0.001) and major morbidity (OR, 1.31; 95% CI, 1.08-1.60; P=0.006). When preoperative degree of malnutrition was classified into normal, light, and moderate according to the original CONUT scoring system, short-term surgical outcomes were well stratified as follows: any morbidity, 21.8% vs. 35.1% vs. 51.9% (P=0.001); major morbidity, 6.2% vs. 11.7% vs. 29.6% (P=0.002); and postoperative hospital stay, 11 days vs. 11 days vs. 12 days (P=0.006). Conclusions: The CONUT score could be a simple and reliable predictor of short-term surgical outcomes of patients undergoing hepatectomy for CLM.
背景:据报道，各种营养/炎症评分与腹部手术的手术结果相关，但哪一种评分在预测结直肠癌肝转移(CLM)患者的短期手术结果方面效果最好尚不明确。方法:回顾性分析267例CLM患者367例肝切除术的临床资料。术前营养/炎症状态通过14个报告的营养/炎症评分来确定，并比较这些评分对短期手术结果的预测能力。结果:在受试者工作特征曲线分析中，控制营养状况(CONUT)评分在预测术后主要发病率(曲线下面积[AUC]， 0.650)方面表现最好，在预测术后总体发病率(AUC, 0.622)方面也有类似的趋势。多因素分析证实，CONUT评分与全球发病率均有显著相关性(优势比[OR]， 1.29;95% CI, 1.11-1.49, P=0.001)和主要发病率(OR, 1.31;95% ci, 1.08-1.60;P = 0.006)。术前根据原始CONUT评分系统将营养不良程度分为正常、轻度和中度，短期手术结果分层如下:任何发病率，21.8% vs. 35.1% vs. 51.9% (P=0.001);重度发病率，6.2% vs. 11.7% vs. 29.6% (P=0.002);术后住院时间:11天vs. 11天vs. 12天(P=0.006)。结论:CONUT评分可以简单可靠地预测CLM肝切除术患者的短期手术结果。
{"title":"Comparison of Nutritional/Inflammatory Scores as a Preoperative Predictor of Short-Term Surgical Risks in Hepatectomy for Colorectal Metastasis","authors":"Ryosuke Umino, J. Shindoh, Yuta Kobayashi, Miho Akabane, Kazutaka Kojima, S. Okubo, M. Hashimoto","doi":"10.21614/sgo-26-2-279","DOIUrl":"https://doi.org/10.21614/sgo-26-2-279","url":null,"abstract":"Background: Various nutritional/inflammatory scores reportedly correlate with surgical outcomes of abdominal surgery, while it remains inconclusive which one is the best in prediction of short-term surgical outcomes of patients with colorectal liver metastasis (CLM). Methods: Clinical records of 367 hepatectomies for 267 patients with CLM were retrospectively reviewed. Preoperative nutritional/inflammatory status was determined using 14 reported nutritional/inflammatory scores and predictive powers of these scores for short-term surgical outcomes were compared. Results: In receiver operating characteristics curve analysis, controlling nutritional status (CONUT) score showed the highest performance in prediction of major postoperative morbidity (area under the curve [AUC], 0.650) among the tested scores and similar tendency was also confirmed in prediction of global postoperative morbidity (AUC, 0.622). Multivariate analysis confirmed that the CONUT score showed significant correlation with both global morbidity (odds ratio [OR], 1.29; 95% CI, 1.11-1.49, P=0.001) and major morbidity (OR, 1.31; 95% CI, 1.08-1.60; P=0.006). When preoperative degree of malnutrition was classified into normal, light, and moderate according to the original CONUT scoring system, short-term surgical outcomes were well stratified as follows: any morbidity, 21.8% vs. 35.1% vs. 51.9% (P=0.001); major morbidity, 6.2% vs. 11.7% vs. 29.6% (P=0.002); and postoperative hospital stay, 11 days vs. 11 days vs. 12 days (P=0.006). Conclusions: The CONUT score could be a simple and reliable predictor of short-term surgical outcomes of patients undergoing hepatectomy for CLM.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73614723","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}
C. Alexander, R. Kay, Sajid Waheed Rahman, C. Deans
Background: Unpleasant abdominal symptoms are common following surgery for upper gastrointestinal (UGI) cancer and may occur secondary to pancreatic exocrine insufficiency (EPI). This study investigated symptoms of EPI in patients following surgery and assessed the effect of pancreatic enzyme supplementation (PERT) on these symptoms and the effect of supplementation on quality of life. Methods: Patients were assessed for symptoms of EPI using a novel questionnaire. Patients who reported two or more symptoms suggestive of EPI were prescribed PERT. Abdominal symptoms were reassessed following treatment. Quality of life (QoL) was studied using the SF-36 questionnaire before and after treatment. Faecal elastase was measured in a patient subgroup. Results: Fifty-six out of 57 patients (98%) reported at least two symptoms of EPI. Following PERT every patient reported fewer abdominal symptoms; median 5 symptoms before treatment reduced to two symptoms following treatment (p<0.0001; Wilcoxon rank). Reduced faecal elastase concentration was associated with more frequent abdominal symptoms; median 5 symptoms versus 3 symptoms (p = 0.043; Mann Whitney U test). PERT increased quality of life scores for every patient in each of the 5 principle health domains. Conclusion: Symptoms of EPI are common among patients following UGI cancer surgery. PERT reduces unpleasant abdominal symptoms and this leads to significant improvements in quality of life across global health domains. PERT should be offered to all post-operative UGI cancer patients with symptoms suggestive of EPI.
{"title":"Pancreatic Enzyme Supplementation Improves Quality of Life in Patients Following Surgery for Upper GI Cancer","authors":"C. Alexander, R. Kay, Sajid Waheed Rahman, C. Deans","doi":"10.21614/sgo-26-2-322","DOIUrl":"https://doi.org/10.21614/sgo-26-2-322","url":null,"abstract":"Background: Unpleasant abdominal symptoms are common following surgery for upper gastrointestinal (UGI) cancer and may occur secondary to pancreatic exocrine insufficiency (EPI). This study investigated symptoms of EPI in patients following surgery and assessed the effect of pancreatic enzyme supplementation (PERT) on these symptoms and the effect of supplementation on quality of life. Methods: Patients were assessed for symptoms of EPI using a novel questionnaire. Patients who reported two or more symptoms suggestive of EPI were prescribed PERT. Abdominal symptoms were reassessed following treatment. Quality of life (QoL) was studied using the SF-36 questionnaire before and after treatment. Faecal elastase was measured in a patient subgroup. Results: Fifty-six out of 57 patients (98%) reported at least two symptoms of EPI. Following PERT every patient reported fewer abdominal symptoms; median 5 symptoms before treatment reduced to two symptoms following treatment (p<0.0001; Wilcoxon rank). Reduced faecal elastase concentration was associated with more frequent abdominal symptoms; median 5 symptoms versus 3 symptoms (p = 0.043; Mann Whitney U test). PERT increased quality of life scores for every patient in each of the 5 principle health domains. Conclusion: Symptoms of EPI are common among patients following UGI cancer surgery. PERT reduces unpleasant abdominal symptoms and this leads to significant improvements in quality of life across global health domains. PERT should be offered to all post-operative UGI cancer patients with symptoms suggestive of EPI.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84228504","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}
Mostafa M. Elghalban, M. Ghazaly, A. Darwish, A. Elnemr, W. Y. E. Sherpiny
Background: Oncoplastic surgery has gained wide popularity. Batwing mastopexy (BWM) is an oncoplastic technique being used in treatment of centrally located tumors. The purpose of our study is to assess short-term outcome including cosmetic results of this technique done for peri-areolar lesions in breast upper quadrants. Methods: A prospective study of a series of 25 women with upper quadrants peri-areolar breast cancer. 23 patients underwent wide local excision with clear margins accompanied by BWM in order to achieve pleasant outcome. Separate incisions were performed for axillary biopsy or dissection for invasive cancers. Four months after surgery, the cosmetic result was evaluated both objectively by the surgeons (five elements of the ABNSW system) and subjectively by patients regarding their satisfaction. Results: Results were rated as poor, fair, good or excellent. This revealed good result in 18 cases (78%) followed by fair in 4 cases (17%). Again, most patients 18 (78%) expressed good satisfaction with none of them reporting poor outcome either objectively by surgeons or even subjectively. Minor complications occurred in only 5 patients (21.7%), all have been treated conservatively. Conclusion: Batwing mastopexy is a safe, convenient-to-learn, and quick technique. It allows to achieve a favorable breast shape, particularly in women with large breasts.
{"title":"Evaluation of a Single Oncoplastic Technique for Peri-Areolar Upper Quadrants Breast Cancer","authors":"Mostafa M. Elghalban, M. Ghazaly, A. Darwish, A. Elnemr, W. Y. E. Sherpiny","doi":"10.21614/sgo-26-2-297","DOIUrl":"https://doi.org/10.21614/sgo-26-2-297","url":null,"abstract":"Background: Oncoplastic surgery has gained wide popularity. Batwing mastopexy (BWM) is an oncoplastic technique being used in treatment of centrally located tumors. The purpose of our study is to assess short-term outcome including cosmetic results of this technique done for peri-areolar lesions in breast upper quadrants. Methods: A prospective study of a series of 25 women with upper quadrants peri-areolar breast cancer. 23 patients underwent wide local excision with clear margins accompanied by BWM in order to achieve pleasant outcome. Separate incisions were performed for axillary biopsy or dissection for invasive cancers. Four months after surgery, the cosmetic result was evaluated both objectively by the surgeons (five elements of the ABNSW system) and subjectively by patients regarding their satisfaction. Results: Results were rated as poor, fair, good or excellent. This revealed good result in 18 cases (78%) followed by fair in 4 cases (17%). Again, most patients 18 (78%) expressed good satisfaction with none of them reporting poor outcome either objectively by surgeons or even subjectively. Minor complications occurred in only 5 patients (21.7%), all have been treated conservatively. Conclusion: Batwing mastopexy is a safe, convenient-to-learn, and quick technique. It allows to achieve a favorable breast shape, particularly in women with large breasts.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74537265","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}
Octavio A. Gil, Rodrigo Figueroa, M. Yance, F. Pascual, Joaquin Bastet, Rogelio A. Traverso, Carlos H Valenzuela
Background: Biliary complications are the more frequent problem following liver transplantation (LT) and have been considered the “Achiles´s heel”of this procedure. The aim of this study was to evaluate the rates of biliary complications after LT, the different therapeutic modalities currently available and their outcomes. Methods: A total of 420 LTs performed up to 2020 were retrospectively analyzed. Evaluation factors included MELD score, images, surgical techniques, type of biliary reconstruction and type of complications. We also analyzed the different therapeutic options, and the short and long-term outcome. Results: 417 deceased donors and 3 living donor transplants were performed. Biliary complications occurred in 37 patients (8,8%) – 31 strictures (81%), four leaks (11%), one acute biliary peritonitis after T-tube removal (3%) and two patients biliary stones (5%). Biliary complications associated with vascular complications were seen in 10 patients (27%). In general, a minimally invasive management (percutaneous or endoscopic) was the first-line approach. Percutaneous interventional procedures were the treatment of choice in 32/37 patients (86,48%), with a success rate of 67.74% (21/31). Hepaticojejunostomy (HJ) was performed in 14 patients. Overall morbidity rate of surgical reconstruction was 14% (2/14 patients) and perioperative mortality was 7%. The median follow–up was 54,53 months. At follow-up, none of the patients in the HJ group had developed a new stricture. Conclusions: The majority of biliary complications must be treated by minimally invasive approach. However, when those fail,surgical reconstruction allows to avoid future consequences in the graft.
{"title":"Biliary Complications Following Orthotopic Liver Transplantation: the Place of Surgical Reconstruction in the Minimally-Invasive Era","authors":"Octavio A. Gil, Rodrigo Figueroa, M. Yance, F. Pascual, Joaquin Bastet, Rogelio A. Traverso, Carlos H Valenzuela","doi":"10.21614/SGO-26-309","DOIUrl":"https://doi.org/10.21614/SGO-26-309","url":null,"abstract":"Background: Biliary complications are the more frequent problem following liver transplantation (LT) and have been considered the “Achiles´s heel”of this procedure. The aim of this study was to evaluate the rates of biliary complications after LT, the different therapeutic modalities currently available and their outcomes. Methods: A total of 420 LTs performed up to 2020 were retrospectively analyzed. Evaluation factors included MELD score, images, surgical techniques, type of biliary reconstruction and type of complications. We also analyzed the different therapeutic options, and the short and long-term outcome. Results: 417 deceased donors and 3 living donor transplants were performed. Biliary complications occurred in 37 patients (8,8%) – 31 strictures (81%), four leaks (11%), one acute biliary peritonitis after T-tube removal (3%) and two patients biliary stones (5%). Biliary complications associated with vascular complications were seen in 10 patients (27%). In general, a minimally invasive management (percutaneous or endoscopic) was the first-line approach. Percutaneous interventional procedures were the treatment of choice in 32/37 patients (86,48%), with a success rate of 67.74% (21/31). Hepaticojejunostomy (HJ) was performed in 14 patients. Overall morbidity rate of surgical reconstruction was 14% (2/14 patients) and perioperative mortality was 7%. The median follow–up was 54,53 months. At follow-up, none of the patients in the HJ group had developed a new stricture. Conclusions: The majority of biliary complications must be treated by minimally invasive approach. However, when those fail,surgical reconstruction allows to avoid future consequences in the graft.","PeriodicalId":22101,"journal":{"name":"Surgery, Gastroenterology and Oncology","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79029310","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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