Acta Chirurgica Belgica最新文献

Background: The present original study was first conducted by Prof. Apostolakis. The aim of this study was to investigate the frequency of Meckel's diverticulum morphological variations and surgical anatomy in a Greek population. A review of the relevant literature was also conducted by the authors. In addition, we would like to highlight, with this opportunity, the life and scientific work of the respectful Greek Professor of anatomy George Apostolakis.

Methods: 151 formalin-fixed cadavers were dissected in the Anatomy Department of the Medical School of the National and Kapodistrian University of Athens, Greece, in 1932. A review of the relevant literature was also conducted by the authors.

Results: Meckel's diverticulum was found in the case series of Apostolakis in 3.3% from the free (40%) or lateral border (20%) of the ileum. The diverticulum was observed only in male cadavers. Its origin varied, arising either from the free margin of the ileum or from its lateral border. In one case, a triangular serosa's leaflet was noted, extending partly over the diverticular process and partly over the free edge of the ileum. This finding may represent a remnant of the anterior intestinal wall from an embryological perspective.

Conclusion: In this study Meckel's diverticulum is found in a higher frequency than reported in the international literature (2%). With our work we would like to highlight, the life and scientific work of the respectful Greek Professor of anatomy George Apostolakis.

Background: Professor Theodoros Aretaios (1829-1893) was the most prominent figure in Greek Surgery during nineteenth century. Apart from other operations he performed, he focused also on breast surgery.

Methods: Theodoros Aretaios was a prolific writer. He wrote two main textbooks in Greek. The one is a surgical atlas and the other a surgical pathology textbook. Apart from them he left a great archive of the patient he operated on. Most of them refer to breast surgery and will be highlighted by our study.

Results: Except two male patients all the others were women in Theodoros Aretaios' archive, and the vast majority suffered from breast cancer. Benign disease of the breast although more common were mentioned concisely. Theodoros Aretaios performed total or partial mastectomy, lymphadenectomy and he underlined that the excision of the thoracic muscles or even the ribs had nothing to offer apart from aggravating patient's condition allowing us today to understand his pioneering role in the medical thought of his time.

Conclusion: Theodoros Aretaios patient archive about breast diseases is the first systematic review of such patients in Greece, after the creation of the modern Greek State. The great variety of information shows the very high level of theoretical knowledge in breast surgery, which can be also seen by the surgical approach to benign and malignant disease.

Background: Surgical procedures often entail significant blood loss, potentially leading to various complications. Thus, reducing perioperative bleeding is crucial to enhancing patient outcomes. This study systematically evaluates and conducts a meta-analysis on the efficacy of tranexamic acid (TXA) in patients undergoing burn surgery.

Methods: A comprehensive literature search was performed across PubMed, the Cochrane Central Register of Controlled Trials, Embase, and Web of Science databases to identify pertinent clinical studies on the application of TXA in burn-related surgical procedures. The evaluated outcomes included total blood loss, postoperative hemoglobin levels, postoperative hematocrit, intraoperative packed red blood cell (PRBC) transfusion units, incidence of intraoperative transfusion, and duration of hospitalization.

Results: The analysis incorporated seven studies with a total of 427 patients. Compared to the control group, TXA was associated with a significant reduction in total blood loss [MD = -152.17 mL (95% CI: -159.48 to -144.87)], total PRBC units transfused [MD = -0.61 units (95% CI: -0.92 to -0.30)], and intraoperative transfusion incidence [logRR = -0.70 (95% CI: -1.04 to -0.35)]. However, there were no significant differences observed in postoperative hemoglobin levels [MD = 0.47 g/dL (95% CI: -0.12 to 1.06)], postoperative hematocrit [MD = 2.13% (95% CI: -0.66 to 4.92)], or length of hospital stay [MD = -2.80 days (95% CI: -6.44 to 0.83)].

Conclusions: TXA appears to effectively reduce blood loss and the requirement for PRBC transfusions in burn surgery. Further high-quality research is necessary to substantiate these findings.Abbreviations: TXA: tranexamic acid; PRBC: packed red blood cell; MD: mean difference; REML: restricted maximum likelihood; logOR: log odds ratio.

Anaplastic thyroid carcinoma (ATC) is a rare type of thyroid cancer that is characterized by its rapid onset and progression. It tends to metastasize to various organs, including the lungs, brain, bones and, less commonly, the small bowel. This case report describes a 74-year-old woman who had small bowel metastasis leading to obstruction three years after diagnosis and local resection of ATC, followed by adjuvant chemotherapy. The patient presented at the emergency department with abdominal pain and vomiting. A CT-scan of the abdomen showed signs of intestinal perforation, combined with diffuse dilatation of the ileal small bowel, for which a segmental enterectomy was performed. Histological findings of the resected small bowel diagnosed the tumor as a jejunal metastasis of an ATC. The morphology of this lesion was compared to that of this patient's ATC. We present a rare case of small bowel metastasis from ATC which has previously been described in just a few case reports in the medical literature. Therefore, this case report contributes to the limited knowledge available on this condition.

Background: The treatment of acute pancreatitis (AP) with pancreatic and peripancreatic necrosis (PN and PPN) can be challenging. It is unclear why some patients respond to conservative management while others require an invasive treatment. This study aimed to assess the clinical and radiological characteristics of patients with gallstone or alcohol-induced AP with PN and PPN who underwent interventional or non-interventional treatment.

Methods: Subjects with gallstone or alcohol-induced AP and radiological evidence of PN and PPN, from 2010 to 2018, were divided in two treatment-based groups: interventional-percutaneous drainage (PD) and/or surgical necrosectomy-and non-interventional. A comparison of clinical and radiological characteristics between groups was conducted.

Results: Of 99 patients, 18 underwent interventional treatment, 81 conservative management. The interventional group had larger PN (p = 0.010) and a greater proportion of infected necrosis (p = 0.002). Acute necrotic collection (ANC) >10 cm (95% CI 1.26-3.6, OR 1.839, p = 0.012), infected necrosis (95% CI 4.28-61305.6, OR 153.9, p = 0.026), admission to the intensive care unit (ICU) (95% CI 16.79-326,532.21, OR 489.915, p = 0.007), were predictors of interventions. Patients who underwent PD only had up to four drains inserted and 16.7% hospital mortality; subjects who underwent surgery had up to two drains and 33.3% death rate.

Conclusions: Most subjects with severe gallstone and alcohol-related AP were treated medically. Large ANC, infected necrosis, and ICU admission predicted the need for intervention. When an invasive treatment was required, PD alone was effective with a tendency towards repeated drain insertions.

Purpose: To understand the possibilities and the limitations of the modern Greek surgeons during nineteenth century on hernia surgery.

Methods: Research on the authentic medical writings of the Greek physicians during nineteenth century. The majority of them is brought to light for the first time.

Results: The Greek surgeons of the nineteenth century tried a lot to be updated according to the achievements of the European surgeons regarding the surgery of hernias. Many prominent Greek surgeons contributed to the formation of a scientific method in order this to be taught to the medical students and to the other Greek physicians of the time.

Conclusion: In Greece, it was Spyridon Kontoleon who adopted Lister's method to prevent infections, while his team of physicians contributed further in hernia surgery. The earliest documented with a figure hernia case was that of Pavlos Ioannou in 1882. Theodoros Aretaios recorded his cases, demonstrating an interest in hydroceles. Many of his cases may be found in his archive in the National Library of Greece. Procedures' description and vivid depictions paved the way of hernia surgery's evolution in the newly formed Greek state.

Introduction: Percutaneous endoscopic (PEG) and laparoscopic gastrostomy (LG) are two widely used techniques for gastrostomy placement in infants. We aimed to compare the risk of complications using a validated grading system and parent satisfaction.

Methods: Infants undergoing gastrostomy placement in a tertiary referral center were retrospectively included. Local and general complications were graded using the Clavien-Dindo (CD)system and categorized as early (≤ 30 days) vs late (>30 days) postoperatively. Parent satisfaction was evaluated prospectively using a questionnaire (Numeric Rating Scale 0- 10).

Results: Out of 102 patients, 52 underwent LG and 50 PEG. General complications (CD IIIa, IIIb and IV) were rare and occurred all late (n = 3), local complications were common: twice as much minor local early complications occurred in the LG cohort, however this was not statistically significant (28.8% vs 14.0%; p = 0.092). There was a trend toward more major local late CD IIIb complications in the PEG group, but this was not statistically significant (20.4% vs 8.0%; p = 0.088). After button removal, there was a higher risk of gastrocutaneous fistula requiring surgical closure after LG (53.1% vs 26.7% after PEG; p = 0.003). Parental satisfaction was high in both groups (mean score 8.3 for PEG vs 7.9 for LG; p = 0.341).

Conclusion: While the risk of general complications after gastrostomy placement is low, local complications are common. However not significant, PEG was associated with a higher risk of major long-term local complications, while LG required more surgical closures after button removal. Parental satisfaction was high in both groups. Further prospective comparisons are needed.

Background: Infantile hemangiomas are common vascular tumors in childhood that usually undergo spontaneous involution. However, complications may arise, particularly in visible areas such as the centrofacial region, leading to significant aesthetic and functional sequelae. Columellar necrosis is a rare but challenging complication requiring specialized reconstruction techniques.

Methods: This report presents two cases of columellar necrosis caused by infantile hemangiomas. Reconstruction was achieved using a 3-component technique: cartilage grafts for tip support, oral vestibule mucosal flaps for lateral lining, and cutaneous turn out flaps from the columellar stumps for anterior skin coverage.

Results: Both patients achieved excellent functional and aesthetic outcomes. The described technique allowed for reliable reconstruction of the columella, addressing both structural integrity and cosmetic appearance.

Conclusion: Reconstruction of columellar defects, particularly in pediatric cases, is challenging due to the columella's small size and challenging anatomy. The described 3-component technique offers a reproducible and effective approach for isolated columellar defects, ensuring satisfactory functional and aesthetic results.

Background: Although using gloves in surgery dates back to the nineteenth century in modern medicine, it seems that the earliest evidence can be found in the Middle Ages.

Methods: It is a library research-based study on the book of Ḏaḫīre-ye Kāmele, written by Ḥakim Mohammad (Ḥakīm Muhammad), a Persian surgeon in the sixteenth century.

Results: Ḥakim Mohammad advises the surgeons to use a sheath made of sheep testicle skin for their fingers when examining a wound and putting ointment and bandage on it to protect oneself from diseases that are transmitted through the skin and blood, such as people with wounds whose wounds are caused by smallpox, anthrax, leprosy and infectious wounds.

Conclusion: The words of Ḥakim Mohammad suggest a preliminary concept of using surgical gloves to prevent transmitted diseases, dating back to sixteenth century, 3 centuries before its use in modern era.

Background: Cervico-thoracic paragangliomas are rare hypervascular neuroendocrine tumors, with high morbidity and mortality due to locally invasive growth. They are often misdiagnosed in patients with cervical masses. Horner's syndrome, in this case, results from a lesion of the stellate ganglion. Only a few cases in the literature describe paragangliomas affecting the stellate ganglion.

Case report: We report the case of a 61-year-old female with a cervico-thoracic paraganglioma associated with Horner's syndrome. She had no significant medical history. Cervical computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large, highly vascularized antero-superior mediastinal mass measuring 6.8 cm x 5 cm x 9 cm, surrounding the left subclavian and carotid arteries, and slightly compressing the trachea, esophagus, and innominate vein. Surgery provided the definitive diagnosis through histopathological analysis. We highlight the different types of paragangliomas and the challenges in diagnosis. A 2-year follow-up with CT and PET-CT scans confirmed no recurrence of the lesion.

Conclusions: Paragangliomas are rare, slow-growing neuroendocrine tumors that may appear wherever autonomic ganglia are present. Clinical presentations vary, including lesions of the stellate ganglion causing ipsilateral Horner's syndrome. Paragangliomas should be considered in the differential diagnosis of cervico-thoracic masses. Treatment involves complete surgical resection while preserving neurovascular structures.