Acta Chirurgica Belgica最新文献

An 18-year-old male patient presented with abdominal pain, nausea, and diarrhea. Subsequent laboratory investigations involving the patient's blood samples revealed an inflammatory syndrome. Subsequent radiographic investigations (CT scan, MRI, and endoscopic ultrasound with biopsies) led to the discovery of a heterogenic cystic lesion in the tail of the pancreas. Although the investigations orientated the diagnosis towards a pseudopapillary tumor, no certain pathological diagnosis could be obtained. After a multidisciplinary meeting, surgery was chosen as the designated therapeutic option. The patient underwent left pancreatectomy and no complications were encountered. The pathological examination revealed isolated pancreatic tuberculosis. Currently, the patient is under treatment and no longer presents any digestive symptoms.

Introduction: Myxofibrosarcoma usually occurs in the extremities of middle-aged to older adults. Metastatic myxofibrosarcomas generally emerge in the lung. In this case report, we aim to present a case of primary pulmonary myxofibrosarcoma with tumor thrombus extending into the left atrium without pulmonary vein or atrial invasion.

Case presentation: A 55-year-old male who was being followed up due to a pulmonary nodule presented with a mass extending from the left lower lobe to the left atrium. No extrathoracic malignancy was detected in the pre-operative examination. The mass extending into the left atrium without invasion was excised with the lower lobe of the left lung. A post-operative histopathological examination revealed myxofibrosarcoma.

Conclusion: Very few cases of cervical, thoracic wall, mediastinum and cardiac primary myxofibrosarcoma have been documented, and to the best of our knowledge, only one primary pulmonary myxofibrosarcoma case has previously been reported in the English literature. Here, we present a case of primary pulmonary myxofibrosarcoma that extended to the left atrium through the pulmonary vein. In such rare clinical presentations, intracardiac tumor resection should precede pulmonary resection due to the possibility of catastrophic tumor embolisms.

Background: Laparoscopic adjustable gastric banding (LAGB) has been widely performed in the past, however, given its limited weight loss compared to some other procedures, this technique is less often used. Furthermore, a number of complications leading to band removal have been reported in the past few years.

Methods: We present a late acute bowel obstruction by sigmoid strangulation in a female patient with the LAGB performed 15 years ago.

Results: The laparoscopic exploration displayed a post-LAGB intestinal strangulation of the sigmoid loop which was caused by the connecting tube. Since the bowel was still viable, the tube was cut and the obstruction has been successfully resolved. The patient was discharged three days after the surgery.

Conclusion: Although less often performed, knowledge of LAGB complications can be of importance. We believe that, the present strangulation of the sigmoid by the LAGB tubing is the world's first ever case reported. Nevertheless, when it is still proposed to selected patients, an adequate length of the intra-abdominal tubing could reduce the risk of loop formation and prevent this kind of obstruction by internal hernia.

Bacground: Patients who underwent ultrafast track on the operating table and fast track extubation in the pediatric intensive care unit for 2 to 6 h after secundum atrial septal defect surgery in the pediatric age group were compared.

Methods: Between January 2013 and February 2017, 60 pediatric patients (24 boys, 36 girls; Mean age 7.5 ± 4.6 years) whose secundum atrial defect was closed were retrospectively analyzed. The patients were separated as those who were extubated on the operating table (Group1,n = 28) and those extubated in the pediatric intensive care unit within 2-6 h postoperatively (Group2,n = 32).

Results: No difference was found in demographic data and preoperative catheter information between the groups. Cardiopulmonary bypass time was 20(18-25)/27.5(20-30)minutes (p:0.001), the cross-clamp time was 10(10-15)/15(11-20)minutes(p:0.004), the postoperative drainage amount was 50(25-50)/60(32.5-100)ml(p:0.013), the length of stay in the intensive care unit was 1(1--1)/1(1-2)day(p:0.025), the length of stay after intensive care was 3(2-3)/3(3-4)days(p:0.001) and the total hospital stay was 4(3-4)/5(4-5.5) days (p < 0.001), which were respectively shorter for the group 1 compared to 2. Postoperative blood product replacement, positive inotrope support, pericardial effusion, mortality, and morbidity were not detected in either groups.

Conclusion: In this study, it was observed that the UFT extubation was safe for the patients who were operated for secundum ASD, in the pediatric age group, and had a cross-clamp time not exceeding 15 min. It was found that the amount of drainage, length of stay in the intensive care unit, post-intensive care unit, and the total hospital stay of patients extubated on the operating table were shorter.

Background: Urology as a separate surgical specialty is a nineteenth century European development. The background of the origins of this new specialty and the elements that were responsible for it have not been studied in detail, although this information is relevant in view of contemporary challenges.

Methods: The existing literature on the history of Urology and original contemporary documents have been researched and analysed. The information gathered has been matched with documentation on general history.

Results: Urology started as a specialty on its own, separate from (general) surgery, as a consequence of events and decisions after the French Revolution. Before the French Revolution (<1789) there was no well organised healthcare in France, but the French political revolution caused also a medical revolution. The need for further subspecialisation, also within surgery, as a consequence of the revolutionary principles, prompted some brave individuals to limit their activities to specific organs. Several revolutionaries were surgeons specialised in urogenital surgery, and prepared the way for a surgical subspecialty. Jean Civiale developed and promoted specific skills in open and endoscopic interventions of the urogenital tract. Finally Felix Guyon was accepted at the University of Paris as 'Professeur d'Urologie' in 1890, and changed the name of his department into 'Service d'Urologie'. Urology was a fact.

Conclusion: Urology as a separate surgical specialty is the consequence of medical and non-medical developments after the French revolution.

Lymphangioleiomyomatosis (LAM) represents a rare neoplasm affecting almost exclusively women of reproductive age. This condition mainly affects the lungs, but extrapulmonary locations such as the pelvis and the retroperitoneum are possible. Clinical evaluation and ultrasound imaging are usually non-specific, and the diagnosis is obtained through surgical excision and histopathological examination. We report a very rare case of abdominal LAM in a young female patient. A thorough literature review of this rare condition with emphasis on gynecologic implications will be presented. The patient was referred for gynecologic consultation due to pelvic pain and infertility. Unfortunately, despite prompt diagnosis and treatment, the course of the disease was severe and led to patient's exitus in a short time. We encountered an extremely rare deadly pathology mimicking a very common gynecologic condition. The gynecologist must always be alert of possible unexpected conditions that will require prompt attention.

Background: Paraduodenal hernias (PDHs) are the most common congenital internal hernias. Herein, we present a successful laparoscopic repair of a left PDH and we review the minimally invasive techniques that have been used to treat PDHs.

Materials and methods: An 18-year-old female patient with multiple visits to the emergency department for abdominal pain was ultimately diagnosed with a left PDH. She underwent a four-port laparoscopic repair. In order to review the minimally invasive PDH repair techniques used, we searched the PubMed® database and found 53 original studies with a total of 66 minimally invasive PDH repairs (51 left PDH repairs, 15 right PDH repairs) over a period of 24 years (1998-2022).

Results: The patient's postoperative course was uneventful and she was discharged on the 7th postoperative day. The literature review showed that closure of the hernia orifice was performed in 88% of left PDH repairs, whereas wide opening of the hernia orifice with or without mobilization of the right colon was performed in 81% of right PDH repairs. Of the patients with available postoperative data, none experienced complications other than grade Ι according to the Clavien-Dindo classification in the early postoperative period, and only one patient presented symptomatic hernia recurrence at a median follow-up of 1 year.

Conclusions: Based on limited publications and our own experience, minimally invasive repair of PDHs has so far been shown to be feasible and safe in the great majority of cases without irreversible small intestine ischemia/peritonitis.

Background: Acute calculous cholecystitis is a common acute disease in elderly patients. This study aimed to evaluate the efficacy of early laparoscopic cholecystectomy (ELC) compared to percutaneous transhepatic gallbladder drainage (PTGD) for treating acute calculous cholecystitis in elderly patients.

Methods: This retrospective study compared the clinical outcomes of two groups of elderly patients treated with ELC (group A) and PTGD (group B) from January 2018 to December 2021. Preoperative clinical characteristics and postoperative treatment outcomes were analyzed for both groups.

Results: There were no statistically significant differences in preoperative clinical characteristics between the ELC and PTGD groups. ELC took longer to perform (69.8 ± 15.9 min vs. 29.6 ± 5.3 min, p < 0.001) but resulted in a significantly shorter duration of pain (1.9 ± 0.9 days vs. 3.9 ± 1.0 days, p < 0.001) and hospital stay (6.3 ± 2.5 days vs. 9.9 ± 3.6 days, p < 0.001), and a lower rate of sepsis (3.4% vs. 16.9%, p < 0.019). Time to soft diet was faster in the ELC group (1.5 ± 0.9 days vs. 3.0 ± 1.6 days, p < 0.001). Fewer patients in the ELC group experienced surgical reintervention than in the PTGD group (0% vs. 5.6%, p = 0.043). The incidence of postoperative complications and readmission rates in the ELC group were significantly lower than those in the PTGD group (ELC, 3.6%; PTGD, 25.4%, p = 0.001).

Conclusions: ELC is an effective treatment option for acute calculous cholecystitis in elderly patients, and has the added benefits of low postoperative complication rates, rapid recovery, shorter duration of pain, and excellent curative effects as compared to PTGD.

Introduction: Current management of metastatic colorectal cancer is based on neoadjuvant chemotherapy. Few studies have reported on surgery procedures in patients with metastatic colorectal cancer. The objective of this study was to describe our institutional experience with emergency surgery performed in patients with metastatic colorectal cancer during chemotherapy.

Patients and methods: This was a retrospective cohort study including adult patients of ≤80 years with a metastatic colorectal cancer between 2017 and 2020 and undergoing surgery during chemotherapy. Statistical analyses were based on Kaplan-Meier's curve and Cox proportional hazard model. The surgery statistical risk during chemotherapy was studied through all tumor and patient's characteristics. Multivariable logistic regression models were used to identify predictive factors of emergency surgery in these patients.

Results: Seventy-two cases were identified and 60% patients undergone an emergency surgery. By Kaplan-Meier's analyses, intestinal surgery was much more frequent and early in patients who have severe stenosis (either blocking or only permeable using a gastroscope) at the time of diagnosis. Patients with severe malignant stenosis presented a 6.28 time higher surgery risk (p < .0001). The median time between admission and surgery was 54 days in patients with severe stenosis who were operated.

Conclusion: The degree of colorectal tumor stenosis measured by endoscopy was a risk factor for emergency surgery in patients with metastatic colorectal cancer during neoadjuvant chemotherapy. In this group of patients presenting low survival outcomes, further studies are needed to define the place of preventive surgery, avoiding emergency surgery and morbidity in such fragile patients.