International Journal of Surgery Open最新文献

Background

Anal fistulas are relatively common. Despite diverse treatment modalities and tremendous advance and optimization of surgical approaches, considerable recurrence and high failure rates are not uncommon especially after surgery for complex anal fistulas. Therefore, autologous adipose-derived stem cell therapy for the treatment of complex perianal fistula can be an innovative and promising option with potential high cure rate and long-term healing.

Aim

To assess the efficacy and feasibility intralesional administration of stromal vascular fraction containing autologous, adipose-derived stem cells prepared from fresh lipoaspirate for management of complex and recurrent anal fistula.

Methods

Totally, 28 patients with complex perianal fistulas were enrolled in this prospective case-series study from March 2018 and August 2022. They were 22 male and 6 females patient) with 38.8 years average ages (ranges from 26 to 54 years). All patients were assigned to receive intralesional injection with autologous freshly prepared adipose-derived stem cells from lipoaspirate suction in a concentration of 1 × 10⁷ cell/ml. The healing of fistulas, confirmed by clinical assessment and magnetic resonance imaging was evaluated at week 6 weeks, 12 weeks and 6 months after treatment. If no evidence of healing was not seen at 6 weeks, a second dose of same concentration was administered. In addition to fistula healing, adverse effect (functional outcomes), complications and procedure safety were also evaluated.

Results

The overall healing rate of fistulas treated by injection of ADSCs was 60.7% (17/28), while healing rate after first injection was 50% (14/28) and after second injection was 30% (3/10).Three patients were lost after first injection. During the follow up period of 6 months none of the patients who showed complete healing, recorded relapse of their fistulas (recurrence 0%). Further, none of the patients recorded complications or adverse reactions related to stem cell therapy during the study and none of them had worsening fecal incontinence during follow-up period. Postoperative pain assessed by.

VAS score was significantly low (>3). Fecal continence assessed by Wexner score of all patients was not changed or affected.

Conclusions

Injection of complex perianal fistulas by freshly prepared autologous ADSCs could be a valid and effective treatment modality. It is safe, feasible and minimally invasive procedure that lacks the risk of injury to anal sphincter complex, unlike other surgical procedures that endanger the anal continence.Further, second dose of ADSCs injection could improve the rate of healing, without adding adverse effects.

Background

Postoperative pain control is critical after abdominal surgery. primary researches suggest that vitamin D and nasal calcitonin spray may have an effect in reducing postoperative pain.

Objective

This study aims to compare postoperative abdominal pain, in patients who received a combination of Nasocalcin spray and vitamin D to those who received Nasocalcin spray.

Methods

In this double-blind randomized clinical trial, 34 patient candidates for abdominal surgery were selected. They were randomly divided into 2 groups (group A (N = 17) received vitamin D and Nasocalcin spray, and group B (N = 17) received Nasocalcin spray). The drugs have been administered to patients 1 h before surgery. Equivalent amounts of Nasocalcin and intramuscular distilled water were administered to the calcitonin group. after the surgery Patients’' pain levels were measured using a visual analog scale (VAS) after they had gained full consciousness and 6, 12, and 24 h after surgery. the amount of narcotics injected in the first 24 h after surgery was monitored and compared between the two groups.

Results

There was no significant relation between the groups in terms of age (p = 0.98), gender distribution (p = 0.1), surgery duration (p = 0.35), and pain scores after surgery (p = 0.67). In comparison to group B, at 6 h (p = 0.007), 12 h (p = 0.001), and 24 h (p = 0.003), group A reported significantly less pain. There was a significant reduction in total narcotic injected (p = 0.003) in group A.

Conclusions

Preoperative administration of vitamin D with nasal calcitonin spray improved postoperative pain control compared to nasal calcitonin. This non-opioid drug combination represents a preemptive medication for enhanced recovery after abdominal surgery.

Introduction and Importance

Situs Inversus Totalis (SIT) is a rare congenital condition resulting in the complete reversal of thoracoabdominal solid organs. Although rare, it has a higher prevalence in males with an incidence of 1:10,000. The embryonic rotation of the midgut occurs in the opposite direction, leading to a mirror-image arrangement of all visceral organs in both the thorax and abdomen. While individuals with this condition generally live without complications, its importance lies in the differences and difficulties encountered during operative procedures, particularly organ transplantations.

Case presentation

In this article we have presented 3 cases of situs inversus with different complications, admitted in a month, an 83 year-old woman with cholecystitis, a 46 year-old woman with spontaneous peritonitis caused by peptic ulcer perforation and a 26 year-old young man with volvulus of sigmoid.

Clinical Discussion

We have provided a comprehensive description of this uncommon medical condition, including its various facets and associated complications. Medical literature has been searched to find more relevant information about SITs for better optimal planning in surgery.

Conclusion

Situs Inversus Totalis can create challenges in clinical practice, particularly in surgical procedures, due to the reversal of anatomy. Although it does not inherently cause specific complications, it can complicate the diagnosis and management of certain medical conditions. Accurate imaging is crucial for diagnosis and treatment planning. Healthcare professionals must remain vigilant and adaptable when treating patients with SIT.

Introduction

Twisted ovarian cysts are acute conditions that cause sudden pain in the lower abdomen and may occur in older people. A twisted ovarian cyst presents as a complex cyst picture on ultrasound and CT scans and may mimic malignant ovarian masses. A normal CA-125 level in an older woman with a complex ovarian cyst who presents with acute pelvic pain may indicate a twisted ovarian cyst.

Case presentation

A 62-year-old woman presented with acute pelvic pain. A CT scan revealed a cystic ovarian mass with a diameter of 15,1 cm x 10,2 cm x 11,2 cm. Additionally, thick septations and multiple projected mural nodules were detected with normal CA-125 levels.

Discussion

The patient underwent an exploratory laparotomy. Subsequently, a midline incision was made and 100 ml of hemorrhagic ascites was observed. Macroscopic examination of the left ovary revealed an ovarian cyst with necrosis and bleeding, weighing 830 g, and measuring 15 × 12 × 8 cm. Histopathological examination of the cyst revealed serous cystadenoma.

Conclusion

This case suggests that a twisted ovarian cyst may occur in old age; therefore, in older women with complaints of sudden pain in the lower abdomen, a twisted ovarian cyst should be suspected. In post-menopausal women, ovarian masses may not be indicative of a malignancy. However, a twisted benign ovarian cyst should be considered if a complex ovarian mass with acute pelvic pain and normal CA-125 levels is found.

More than 700,000 pacemakers (PMs) are implanted worldwide each year, with more than 250,000 deployed in the United States. Leadless cardiac pacemakers (LPCs) are an alternative to conventional pacemakers because they do not require permanent transvenous leads while alleviating bradyarrhythmias. An innovation in the field of pacing systems called ‘dual chamber pacing system’ has received US Food and Drug Administration (FDA) approval which is a safe, non-invasive, and efficacious procedure as documented by a landmark clinical study. It succeeded in its pre-established safety and performance goals, with definite procedural success, atrial pacing and reliable atrioventricular (AV) synchrony. Despite its hailing success, the system continues to undergo transformation and development, and requires further longitudinal data to reaffirm its safety and efficacy.

Introduction

Laparoscopic subtotal cholecystectomy (LSC) is recognized as a safe, feasible alternative method for avoiding common bile duct injuries in 'difficult' gallbladders. We describe the details of an LSC technique that uses a linear stapler with the reconstituting method for severe cholecystitis.

Methods

We retrospectively analyzed the cases of 19 Japanese patients diagnosed with acute cholecystitis who underwent LSC (Jan. 2017–Dec. 2020). In each patient, we first attempted to perform a standard laparoscopic cholecystectomy. Four trocars were inserted in all patients. When it was extremely difficult to expose and dissect the triangle of Calot or the neck of the gallbladder due to severe inflammation and fibrosis, an LSC was performed. The gallbladder was divided downward from the gallbladder fundus to the neck. We opened the gallbladder wall at the fundus and removed all gallstones with suction and saline flushing. The gallbladder was transected by a laparoscopic linear stapler.

Results

The median operation time was 166 min; intraoperative blood loss was 35 mL. One patient (5.3%) had minor bile leakage that promptly resolved after the transpapillary approach. The median postoperative hospital stay was 7 days.

Conclusion

Using a linear stapler to divide the gallbladder neck is a simple, feasible strategy for LSCs in difficult gallbladders.