Pub Date : 2021-12-30DOI: 10.15388/lietchirur.2021.20.51
Pawan Sharma, V. Nair, Simarjit Singh Rehsi, Vivek Kumar Singh
The idiopathic variant of sclerosing Intraperitoneal fibrosis is a rare pathological entity causing intestinal obstruction. Even though it is described since the beginning of the last century, we are still clueless about the aetiology of this problem. The presentation is often confusing and the clinical and laboratory values will be not confirmatory to establish a diagnosis. A Contrast-enhanced CT scan is a vital investigation of choice. Here we discuss a case of intestinal obstruction with a preop diagnosis of internal herniation, which turned out to be a case of massive intraperitoneal fibrosis. The histopathology was not significant, and no secondary cause was identified. The case report throws wisdom into the existence of this entity and how with a CT scan we can suspect it before surgery. With adequate and meticulous enterolysis we can surgically rehabilitate these patients so that they can lead a normal life.
{"title":"A Rare Case Report of Idiopathic Abdominal Cocoon Presenting as Acute Intestinal Obstruction-Management Challenges","authors":"Pawan Sharma, V. Nair, Simarjit Singh Rehsi, Vivek Kumar Singh","doi":"10.15388/lietchirur.2021.20.51","DOIUrl":"https://doi.org/10.15388/lietchirur.2021.20.51","url":null,"abstract":"The idiopathic variant of sclerosing Intraperitoneal fibrosis is a rare pathological entity causing intestinal obstruction. Even though it is described since the beginning of the last century, we are still clueless about the aetiology of this problem. The presentation is often confusing and the clinical and laboratory values will be not confirmatory to establish a diagnosis. A Contrast-enhanced CT scan is a vital investigation of choice. Here we discuss a case of intestinal obstruction with a preop diagnosis of internal herniation, which turned out to be a case of massive intraperitoneal fibrosis. The histopathology was not significant, and no secondary cause was identified. The case report throws wisdom into the existence of this entity and how with a CT scan we can suspect it before surgery. With adequate and meticulous enterolysis we can surgically rehabilitate these patients so that they can lead a normal life.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47942267","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 : 2021-04-16DOI: 10.15388/LIETCHIRUR.2021.20.39
Mantas Fomkinas, Mantas Kievišas, Kęstutis Braziulis, R. Rimdeika
Objective. To evaluate the results of scaphoid bone proximal pole reconstruction with rib osteochondral autograft due to comminuted scaphoid fracture. Material and methods. We present a clinical case of fragmented scaphoid bone proximal pole fracture reconstruction by rib osteochondral autograft. The modified wrist function score of Green and O’Brien and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measuring scales were used for clinical evaluation before and 6 months after the reconstruction. Additionally, a literature review was conducted for case reports and previous literature reviews describing scaphoid bone proximal pole fracture surgical treatment. Medline (PubMed), ScienceDirect and UpToDate databases were used. Results. Conventional treatment methods for the treatment of comminuted proximal pole scaphoid bone fractures are often inappropriate due to technical issues or potential adverse outcomes. In these cases, reconstruction with rib autograft is possible. The study patient’s modified wrist function score of Green and O’Brien increased from 75 to 95 points out of 100 at 6 months postoperatively, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score decreased from 13.64 to 4.55 points. The results of this technique have been investigated in several studies (Sandow, 1998, 2001; Veitch et al., 2007). All subjects (22, 47 and 14 patients, respectively), except one, experienced improvement of wrist function – enhanced wrist movement, grip strength, reduced pain and restored wrist function to the pre-injury performance level. Conclusions. Scaphoid bone proximal pole fragmented fracture reconstruction with osteochondrial rib autograft achieves favorable recovery of wrist function and avoids complications or unfavorable functional consequences of alternative surgical procedures.
目标。目的评价粉碎性舟状骨骨折用自体肋骨骨软骨移植重建舟状骨近端极的效果。材料和方法。我们报告一例自体肋骨骨软骨移植重建舟状骨近端骨折的临床病例。采用改良的Green和O 'Brien腕部功能评分和快速手臂、肩和手残疾(QuickDASH)结局测量量表进行重建前和重建后6个月的临床评估。此外，我们还对病例报告和先前关于舟状骨近端骨折手术治疗的文献综述进行了文献回顾。使用Medline (PubMed)、ScienceDirect和UpToDate数据库。结果。由于技术问题或潜在的不良后果，常规治疗方法治疗粉碎性舟状骨近端骨折往往不合适。在这种情况下，自体肋骨移植重建是可能的。术后6个月，研究患者的改良腕部功能Green和O 'Brien评分从75分(满分100分)提高到95分，手臂、肩膀和手的快速残疾(QuickDASH)评分从13.64分下降到4.55分。这项技术的结果已经在几项研究中进行了调查(Sandow, 1998,2001;Veitch et al.， 2007)。除1例患者外，所有受试者(分别为22例、47例和14例)的腕功能均得到改善——腕运动增强、握力增强、疼痛减轻，腕功能恢复到损伤前的水平。结论。自体骨软骨肋移植重建舟状骨近极碎片性骨折，可实现腕部功能的良好恢复，避免并发症或其他外科手术的不利功能后果。
{"title":"Scaphoid Fracture Reconstruction with Rib Autograft: Case Report and Literature Review","authors":"Mantas Fomkinas, Mantas Kievišas, Kęstutis Braziulis, R. Rimdeika","doi":"10.15388/LIETCHIRUR.2021.20.39","DOIUrl":"https://doi.org/10.15388/LIETCHIRUR.2021.20.39","url":null,"abstract":"Objective. To evaluate the results of scaphoid bone proximal pole reconstruction with rib osteochondral autograft due to comminuted scaphoid fracture. Material and methods. We present a clinical case of fragmented scaphoid bone proximal pole fracture reconstruction by rib osteochondral autograft. The modified wrist function score of Green and O’Brien and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measuring scales were used for clinical evaluation before and 6 months after the reconstruction. Additionally, a literature review was conducted for case reports and previous literature reviews describing scaphoid bone proximal pole fracture surgical treatment. Medline (PubMed), ScienceDirect and UpToDate databases were used. Results. Conventional treatment methods for the treatment of comminuted proximal pole scaphoid bone fractures are often inappropriate due to technical issues or potential adverse outcomes. In these cases, reconstruction with rib autograft is possible. The study patient’s modified wrist function score of Green and O’Brien increased from 75 to 95 points out of 100 at 6 months postoperatively, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score decreased from 13.64 to 4.55 points. The results of this technique have been investigated in several studies (Sandow, 1998, 2001; Veitch et al., 2007). All subjects (22, 47 and 14 patients, respectively), except one, experienced improvement of wrist function – enhanced wrist movement, grip strength, reduced pain and restored wrist function to the pre-injury performance level. Conclusions. Scaphoid bone proximal pole fragmented fracture reconstruction with osteochondrial rib autograft achieves favorable recovery of wrist function and avoids complications or unfavorable functional consequences of alternative surgical procedures.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47776066","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 : 2020-12-29DOI: 10.15388/lietchirur.2020.19.30
S. Tahir, A. Nikolovski, Martina Ambardjieva, P. Markov, D. Mladenovik, G. Selim, B. Zafirova-Ivanovska, V. Janevski
Introduction. The diagnosis of acute appendicitis (AA), as the most common cause of acute abdominal pain, has changed in the past decade by introducing scoring systems in addition to the use of clinical, laboratory parameters, and radiological examinations. This study aimed to assess the significance of the four scoring systems (Alvarado, Appendicitis Inflammatory Response (AIR), Raya Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis) in the prediction of delayed appendectomy. Materials and methods. The study included 100 respondents, who were diagnosed with AA in the period from January 2018 to February 2019 and were also operated on. In addition to the clinical, laboratory, and ultrasonographic examinations, four scoring systems (Alvarado, AIR, RIPASA, and Tzanakis) were used to diagnose AA. According to the obtained histopathological (HP) findings, the patients were divided into 3 groups: timely appendectomy, delayed appendectomy and unnecessary appendectomy. Using the sensitivity and specificity of all 4 scoring systems, ROC analysis was performed to predict delayed appendectomy. Results. In the study that included 100 patients (58% men, 42% women), after the appendectomy was performed, the resulting HP showed that 74% had a timely appendectomy, while 16% had delayed and 10% had an unnecessary appendectomy. For the prediction of delayed appendectomy, the area under the ROC curve showed a value of 0.577 for the Alvarado score, 0.504 for the AIR, 0.651 for the RIPASA, and 0.696 for the Tzanakis. Sensitivity and specificity for the Alvarado score was 54% and 62%, for RIPASA 62.5% and 63.5%, for Tzanakis 69% and 60.8%, respectively. Combining the three scoring systems (Alvarado, RIPASA, and Tzanakis), the surface area under the ROC curve was 0.762 (95% CI 0.521–0.783), with a sensitivity of 85% and a specificity of 62%. Conclusion. In our study, the diagnostic accuracy of RIPASA and Tzanakis showed better results than Alvarado, while AIR cannot be used to predict delayed appendectomy in our population. However, the simultaneous application of all three scoring systems, RIPASA, Tzanakis and Alvarado, has shown much better discriminatory ability, with higher sensitivity and specificity, as opposed to their use alone. Combining scoring systems should help in proper diagnosis to avoid negative appendectomy, but additional studies with a larger number of patients are needed to support these results.
介绍作为急性腹痛最常见的原因，急性阑尾炎（AA）的诊断在过去十年中发生了变化，除了使用临床、实验室参数和放射学检查外，还引入了评分系统。本研究旨在评估四种评分系统（Alvarado、阑尾炎炎症反应（AIR）、Raya Isteri Pengiran Anak Saleha阑尾炎（RIASA）和Tzanakis）在预测延迟性阑尾切除术中的意义。材料和方法。该研究包括100名受访者，他们在2018年1月至2019年2月期间被诊断为AA，并接受了手术。除了临床、实验室和超声检查外，还使用了四个评分系统（Alvarado、AIR、RIASA和Tzanakis）来诊断AA。根据获得的组织病理学（HP）结果，将患者分为3组：及时阑尾切除术、延迟阑尾切除术和非必要阑尾切除术。利用所有4个评分系统的敏感性和特异性，进行ROC分析以预测延迟阑尾切除术。结果。在这项包括100名患者（58%为男性，42%为女性）的研究中，在进行阑尾切除术后，HP显示74%的患者及时进行了阑尾切除术，16%的患者延迟进行，10%的患者进行了不必要的阑尾切除术。对于延迟阑尾切除术的预测，ROC曲线下的面积显示Alvarado评分为0.577，AIR评分为0.504，RIASA评分为0.651，Tzanakis评分为0.696。Alvarado评分的灵敏度和特异性分别为54%和62%，RIASA评分的灵敏度为62.5%和63.5%，Tzanakis评分的敏感性和特异性为69%和60.8%。结合三种评分系统（Alvarado、RIASA和Tzanakis），ROC曲线下的表面积为0.762（95%CI 0.521-0.783），敏感性为85%，特异性为62%。结论。在我们的研究中，RIASA和Tzanakis的诊断准确性显示出比Alvarado更好的结果，而AIR不能用于预测我们人群中延迟的阑尾切除术。然而，与单独使用相比，同时应用RIASA、Tzanakis和Alvarado这三种评分系统显示出更好的辨别能力，具有更高的敏感性和特异性。结合评分系统应有助于正确诊断，避免阑尾切除术阴性，但需要对更多患者进行额外的研究来支持这些结果。
{"title":"Predictive Value of Alvarado, Acute Inflammatory Response, Tzanakis and RIPASA Scores in the Diagnosis of Acute Appendicitis","authors":"S. Tahir, A. Nikolovski, Martina Ambardjieva, P. Markov, D. Mladenovik, G. Selim, B. Zafirova-Ivanovska, V. Janevski","doi":"10.15388/lietchirur.2020.19.30","DOIUrl":"https://doi.org/10.15388/lietchirur.2020.19.30","url":null,"abstract":"Introduction. The diagnosis of acute appendicitis (AA), as the most common cause of acute abdominal pain, has changed in the past decade by introducing scoring systems in addition to the use of clinical, laboratory parameters, and radiological examinations. This study aimed to assess the significance of the four scoring systems (Alvarado, Appendicitis Inflammatory Response (AIR), Raya Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and Tzanakis) in the prediction of delayed appendectomy. Materials and methods. The study included 100 respondents, who were diagnosed with AA in the period from January 2018 to February 2019 and were also operated on. In addition to the clinical, laboratory, and ultrasonographic examinations, four scoring systems (Alvarado, AIR, RIPASA, and Tzanakis) were used to diagnose AA. According to the obtained histopathological (HP) findings, the patients were divided into 3 groups: timely appendectomy, delayed appendectomy and unnecessary appendectomy. Using the sensitivity and specificity of all 4 scoring systems, ROC analysis was performed to predict delayed appendectomy. Results. In the study that included 100 patients (58% men, 42% women), after the appendectomy was performed, the resulting HP showed that 74% had a timely appendectomy, while 16% had delayed and 10% had an unnecessary appendectomy. For the prediction of delayed appendectomy, the area under the ROC curve showed a value of 0.577 for the Alvarado score, 0.504 for the AIR, 0.651 for the RIPASA, and 0.696 for the Tzanakis. Sensitivity and specificity for the Alvarado score was 54% and 62%, for RIPASA 62.5% and 63.5%, for Tzanakis 69% and 60.8%, respectively. Combining the three scoring systems (Alvarado, RIPASA, and Tzanakis), the surface area under the ROC curve was 0.762 (95% CI 0.521–0.783), with a sensitivity of 85% and a specificity of 62%. Conclusion. In our study, the diagnostic accuracy of RIPASA and Tzanakis showed better results than Alvarado, while AIR cannot be used to predict delayed appendectomy in our population. However, the simultaneous application of all three scoring systems, RIPASA, Tzanakis and Alvarado, has shown much better discriminatory ability, with higher sensitivity and specificity, as opposed to their use alone. Combining scoring systems should help in proper diagnosis to avoid negative appendectomy, but additional studies with a larger number of patients are needed to support these results.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47823927","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 : 2020-12-29DOI: 10.15388/lietchirur.2020.19.28
Brigita Siparytė-Sinkevičienė, R. Rimdeika
People recovering from burn injury experience a wide range of challenges throughout their recovery. Currently, the survival is not the only important issue in the treatment of burns. As the advancement and amelioration in burn treatment have improved significantly, the patients’ recovery and abilities to return to their pre-burn functional status are of equal importance as well. The results of recent scientific literature review (Kazis et al.) demonstrate that 28% of burn survivors never return to any form of employment and only 37% of burn survivors regain the fullness of previous employment. Physical therapy is a critical, though painful, component of burn rehabilitation therapy and includes a variety of physiotherapy treatment methods such as exercise therapy, cardiopulmonary training, joint mobilization, positioning, splint adjustment, etc. The application of physiotherapy after burn injury was found to improve physical capacity, muscle strength, body composition, and quality of life. The use of early physiotherapy is also recommended in patients treated in the intensive care unit.
{"title":"Physiotherapy after Burns Injury, Acute and Surgical Burn Care Stages: Literature Review","authors":"Brigita Siparytė-Sinkevičienė, R. Rimdeika","doi":"10.15388/lietchirur.2020.19.28","DOIUrl":"https://doi.org/10.15388/lietchirur.2020.19.28","url":null,"abstract":"People recovering from burn injury experience a wide range of challenges throughout their recovery. Currently, the survival is not the only important issue in the treatment of burns. As the advancement and amelioration in burn treatment have improved significantly, the patients’ recovery and abilities to return to their pre-burn functional status are of equal importance as well. The results of recent scientific literature review (Kazis et al.) demonstrate that 28% of burn survivors never return to any form of employment and only 37% of burn survivors regain the fullness of previous employment. Physical therapy is a critical, though painful, component of burn rehabilitation therapy and includes a variety of physiotherapy treatment methods such as exercise therapy, cardiopulmonary training, joint mobilization, positioning, splint adjustment, etc. The application of physiotherapy after burn injury was found to improve physical capacity, muscle strength, body composition, and quality of life. The use of early physiotherapy is also recommended in patients treated in the intensive care unit.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41383635","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 : 2020-12-29DOI: 10.15388/lietchirur.2020.19.34
Karolis Černauskis, Sandra Kružyk, Gabrielė Šukytė, L. Venclauskas, M. Sakalauskas
Introduction. Liposuction is one of the most popular aesthetic surgical procedures. Liposuction is associated with weight loss, but the primary significance of this operation is body lines contouring. According to US plastic surgery statistics for 2018, liposuction surgery was ranked in the top five of cosmetic surgical procedures, and the most common area of suction in the body was the abdomen. One of the most difficult complications after this procedure is perforation of the small or large intestine, with a frequency of 0.014%. In order to avoid this complication, a comprehensive pre-operative, post-operative examination of the patient and ensuring the safety of the operation are important. We presenting a complicated clinical case of liposuction and literature review. Presentation of case report. In July 2019, a 49-year-old patient underwent surgery by plastic surgeons. Abdominal liposuction surgery was performed. On the first postoperative day, the patient complained of diffuse abdominal pain (VAS 7–8 points), but there were no clinical signs of peritonitis. The patient underwent urgent surgery following the development of a clinical picture of sepsis and peritonitis due to tomography. The operation started with diagnostic laparoscopy. On the left side of the abdominal wall, 4–5 mm abdominal wall defects were observed, and the intestinal cavity was rich in intestinal contents. No obvious injuries to the small intestine, colon or other abdominal organs were observed during laparoscopy. Therefore, a laparotomy was performed, during which two perforations of the small intestine were found and sutured. The postoperative period was smooth, with the patient discharged home after 11 bed days. Conclusions. Intestinal perforation after liposuction is a rare but dangerous complication. Although bowel injury is one of the most severe complications. Prevention is possible starting with a detailed clinical examination of the patient in the preoperative period. The postoperative period should be particularly important in light of the patient’s complaints and clinical symptoms. The presented clinical case shows what a complication of abdominal liposuction can be threatening and how important its early diagnosis and vigilance are.
{"title":"Safe Liposuction: Case Report and Review of the Literature","authors":"Karolis Černauskis, Sandra Kružyk, Gabrielė Šukytė, L. Venclauskas, M. Sakalauskas","doi":"10.15388/lietchirur.2020.19.34","DOIUrl":"https://doi.org/10.15388/lietchirur.2020.19.34","url":null,"abstract":"Introduction. Liposuction is one of the most popular aesthetic surgical procedures. Liposuction is associated with weight loss, but the primary significance of this operation is body lines contouring. According to US plastic surgery statistics for 2018, liposuction surgery was ranked in the top five of cosmetic surgical procedures, and the most common area of suction in the body was the abdomen. One of the most difficult complications after this procedure is perforation of the small or large intestine, with a frequency of 0.014%. In order to avoid this complication, a comprehensive pre-operative, post-operative examination of the patient and ensuring the safety of the operation are important. We presenting a complicated clinical case of liposuction and literature review. Presentation of case report. In July 2019, a 49-year-old patient underwent surgery by plastic surgeons. Abdominal liposuction surgery was performed. On the first postoperative day, the patient complained of diffuse abdominal pain (VAS 7–8 points), but there were no clinical signs of peritonitis. The patient underwent urgent surgery following the development of a clinical picture of sepsis and peritonitis due to tomography. The operation started with diagnostic laparoscopy. On the left side of the abdominal wall, 4–5 mm abdominal wall defects were observed, and the intestinal cavity was rich in intestinal contents. No obvious injuries to the small intestine, colon or other abdominal organs were observed during laparoscopy. Therefore, a laparotomy was performed, during which two perforations of the small intestine were found and sutured. The postoperative period was smooth, with the patient discharged home after 11 bed days. Conclusions. Intestinal perforation after liposuction is a rare but dangerous complication. Although bowel injury is one of the most severe complications. Prevention is possible starting with a detailed clinical examination of the patient in the preoperative period. The postoperative period should be particularly important in light of the patient’s complaints and clinical symptoms. The presented clinical case shows what a complication of abdominal liposuction can be threatening and how important its early diagnosis and vigilance are.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43118948","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 : 2020-12-29DOI: 10.15388/lietchirur.2020.19.29
A. Makulavičius, G. Mazarevičius, P. Masionis, Matas Urmanavičius, M. Klinga, V. Uvarovas, N. Porvaneckas
Background. The optimal treatment of acute Achilles tendon ruptures is still under debate. The purpose of this randomized controlled trial was to evaluate outcomes of open repair comparing with percutaneous procedure for Achilles tendon ruptures. Methods. 100 patients with acute Achilles tendon rupture were randomized in two groups: open “crown” type (group A) and percutaneous Bunnell type repair (group B). Absorbable suture was used in both groups. 87 patients were available for the mean follow up of 6 months. Results. No statistically significant difference was observed between groups in ATRS (Achilles Tendon Total Rupture Score), leg circumference, single heel rise, Achilles resting angle, time back to work and sports and overall patient satisfaction. Percutaneous technique was much faster. Overall 13 complications occurred in both groups (5 and 8 respectively). No deep infection occurred, no revisions were needed. Conclusions. Both techniques showed to be effective and safe when using absorbable suture material with a high patient satisfaction and a low complication rate, but percutaneous repair was significantly faster.
{"title":"Short-term Outcomes of Open “Crown” Type v. Percutaneous Bunnell Type Repair of Acute Achilles Tendon Ruptures. Randomized Control Study","authors":"A. Makulavičius, G. Mazarevičius, P. Masionis, Matas Urmanavičius, M. Klinga, V. Uvarovas, N. Porvaneckas","doi":"10.15388/lietchirur.2020.19.29","DOIUrl":"https://doi.org/10.15388/lietchirur.2020.19.29","url":null,"abstract":"Background. The optimal treatment of acute Achilles tendon ruptures is still under debate. The purpose of this randomized controlled trial was to evaluate outcomes of open repair comparing with percutaneous procedure for Achilles tendon ruptures. Methods. 100 patients with acute Achilles tendon rupture were randomized in two groups: open “crown” type (group A) and percutaneous Bunnell type repair (group B). Absorbable suture was used in both groups. 87 patients were available for the mean follow up of 6 months. Results. No statistically significant difference was observed between groups in ATRS (Achilles Tendon Total Rupture Score), leg circumference, single heel rise, Achilles resting angle, time back to work and sports and overall patient satisfaction. Percutaneous technique was much faster. Overall 13 complications occurred in both groups (5 and 8 respectively). No deep infection occurred, no revisions were needed. Conclusions. Both techniques showed to be effective and safe when using absorbable suture material with a high patient satisfaction and a low complication rate, but percutaneous repair was significantly faster.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47920934","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 : 2020-06-10DOI: 10.15388/lietchirur.2020.19.24
Domantas Rainys, Adas Cepas, R. Rimdeika
Aim. The aim of the study was to evaluate and compare the quality of life (QoL) using platelet-rich plasma gel (PRP) and conventional treatment of chronic leg wounds. Methods. Randomized clinical trial was carried out in Hospital of Lithuanian University of Health Sciences Kaunas Clinics during 2014–2018. Patients (n = 69) included in the study were randomly grouped into 2 groups: 1) PRP, 2) Control. SF-36 questionnaire was used to evaluate QoL, visual analog scale was used to evaluate persistent pain associated with ulcer and wound exudate volume was also evaluated. Statistical analysis were performed with SPSS 23.0 package. Results. Patients in PRP group at the end of the treatment rated their QoL over control group patients (p < 0.05). Wound associated pain (PRP – 1.54; control – 2.85; p = 0.015) and pain associated sleep disturbance (p < 0.001) was lower in PRP group patients. Wound exudate volume was lower in PRP group patients at the end of the treatment (p < 0.05). Conclusion. The treatment with PRP is associated with less wound associated pain, less-common sleep disturbance, reduced wound secretion and improved quality of life compared to conventional treatment.
{"title":"Evaluation of Quality of Life in Patients with Chronic Leg Wounds: Can Platelet-rich Plasma Therapy Help?","authors":"Domantas Rainys, Adas Cepas, R. Rimdeika","doi":"10.15388/lietchirur.2020.19.24","DOIUrl":"https://doi.org/10.15388/lietchirur.2020.19.24","url":null,"abstract":"Aim. The aim of the study was to evaluate and compare the quality of life (QoL) using platelet-rich plasma gel (PRP) and conventional treatment of chronic leg wounds. Methods. Randomized clinical trial was carried out in Hospital of Lithuanian University of Health Sciences Kaunas Clinics during 2014–2018. Patients (n = 69) included in the study were randomly grouped into 2 groups: 1) PRP, 2) Control. SF-36 questionnaire was used to evaluate QoL, visual analog scale was used to evaluate persistent pain associated with ulcer and wound exudate volume was also evaluated. Statistical analysis were performed with SPSS 23.0 package. Results. Patients in PRP group at the end of the treatment rated their QoL over control group patients (p < 0.05). Wound associated pain (PRP – 1.54; control – 2.85; p = 0.015) and pain associated sleep disturbance (p < 0.001) was lower in PRP group patients. Wound exudate volume was lower in PRP group patients at the end of the treatment (p < 0.05). Conclusion. The treatment with PRP is associated with less wound associated pain, less-common sleep disturbance, reduced wound secretion and improved quality of life compared to conventional treatment.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43000560","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 : 2020-06-10DOI: 10.15388/lietchirur.2020.19.20
M. Luksta, Raminta Lukšaitė-Lukštė, A. Baušys, K. Strupas
Surgery remains the only potentially curative option for gastric cancer, although it is related to high postoperative morbidity and mortality rate. Approximately every second gastric cancer patient is diagnosed with sarcopenia, which is a significant risk factor for postoperative complications and poor long-term outcomes. However, sarcopenia is underestimated in routine clinical practice, since it remains the interest of clinical trials. Sarcopenia diagnostic criteria are not fully standardized, but it consists of tests for muscle strength, quantity and quality. They include grip strength, chair stand test, computed tomography, magnetic resonance imaging, ultrasound, bioelectrical impedance analysis and densitometry tests. Regarding the growing evidence for sarcopenia impact on surgical gastric cancer treatment results, it is a high probability that sarcopenia assessment will come to routine clinical practice. Although, until then there is a need for further clinical trials to standardize the diagnostic and to find effective treatment strategies.
{"title":"Underestimated Value of Sarcopenia in Gastric Cancer Surgery","authors":"M. Luksta, Raminta Lukšaitė-Lukštė, A. Baušys, K. Strupas","doi":"10.15388/lietchirur.2020.19.20","DOIUrl":"https://doi.org/10.15388/lietchirur.2020.19.20","url":null,"abstract":"Surgery remains the only potentially curative option for gastric cancer, although it is related to high postoperative morbidity and mortality rate. Approximately every second gastric cancer patient is diagnosed with sarcopenia, which is a significant risk factor for postoperative complications and poor long-term outcomes. However, sarcopenia is underestimated in routine clinical practice, since it remains the interest of clinical trials. Sarcopenia diagnostic criteria are not fully standardized, but it consists of tests for muscle strength, quantity and quality. They include grip strength, chair stand test, computed tomography, magnetic resonance imaging, ultrasound, bioelectrical impedance analysis and densitometry tests. Regarding the growing evidence for sarcopenia impact on surgical gastric cancer treatment results, it is a high probability that sarcopenia assessment will come to routine clinical practice. Although, until then there is a need for further clinical trials to standardize the diagnostic and to find effective treatment strategies.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41959608","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 : 2020-06-10DOI: 10.15388/lietchirur.2020.19.22
V. S. Groshilin, V. G. Brizhak, E. Khoronko, P. V. Tsygankov, Y. Khoronko
Aim. Evaluation of the effectiveness and identification of the benefits of a video-assisted fistula treatment method using fistuloscopy, in comparison with traditional methods of surgical treatment of complex forms of chronic paraproctitis, trans- and extrasphincteric, relapsing rectal fistulas. Patients and methods. A complex analysis of the results of surgical treatment was carried out in 228 patients with chronic paraproctitis, transphincteric, ectrasphincteric, including recurrent rectal fistulas, divided into three groups (main and two control), depending on the surgical methods of chronic paraproctitis used. Results. The result of surgical treatment of pararectal fistulas in the three study groups was compared. The effectiveness of treatment was assessed by the results of immediate and long-term postoperative period. It has been established that the use of a video-assisted fistula treatment method using fistuloscopy excludes the presence of an extensive postoperative wound in the perianal region, which significantly reduces the likelihood of its secondary infection, and the sphincter trauma, and in fact virtually eliminates its insufficiency. The use of video-assisted method of treatment of fistulas made it possible to reduce the number of postoperative complications. Conclusion. The final results (92.7% of favorable outcomes) allow us to recommend a video-assisted treatment for fistulas for wide practical implementation.
{"title":"Video-assisted Treatment of Rectal Fistulas: the Experience and Treatment Results","authors":"V. S. Groshilin, V. G. Brizhak, E. Khoronko, P. V. Tsygankov, Y. Khoronko","doi":"10.15388/lietchirur.2020.19.22","DOIUrl":"https://doi.org/10.15388/lietchirur.2020.19.22","url":null,"abstract":"Aim. Evaluation of the effectiveness and identification of the benefits of a video-assisted fistula treatment method using fistuloscopy, in comparison with traditional methods of surgical treatment of complex forms of chronic paraproctitis, trans- and extrasphincteric, relapsing rectal fistulas. Patients and methods. A complex analysis of the results of surgical treatment was carried out in 228 patients with chronic paraproctitis, transphincteric, ectrasphincteric, including recurrent rectal fistulas, divided into three groups (main and two control), depending on the surgical methods of chronic paraproctitis used. Results. The result of surgical treatment of pararectal fistulas in the three study groups was compared. The effectiveness of treatment was assessed by the results of immediate and long-term postoperative period. It has been established that the use of a video-assisted fistula treatment method using fistuloscopy excludes the presence of an extensive postoperative wound in the perianal region, which significantly reduces the likelihood of its secondary infection, and the sphincter trauma, and in fact virtually eliminates its insufficiency. The use of video-assisted method of treatment of fistulas made it possible to reduce the number of postoperative complications. Conclusion. The final results (92.7% of favorable outcomes) allow us to recommend a video-assisted treatment for fistulas for wide practical implementation.","PeriodicalId":52926,"journal":{"name":"Lietuvos Chirurgija","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49016369","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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