Acta Chirurgica Belgica最新文献

Introduction: People's understanding of bladder stones has a long history. Since around the sixth century BC, surgery has been selected as the most specialized and last treatment and has continuously evolved. Meanwhile, many missing links have sometimes been a turning point in bladder stone surgery. The efforts of Iranian medicine scholars in advancing this treatment method are part of the impressive ups and downs of this path, which is discussed in this research.

Methods: This review research is based on Persian medicine sources, such as Al-Hawi fi al-Tabb, The Kitāb al-Taṣrīf, and Al-Qanun fi al-Tebb. It has also used reliable databases such as Pub Med, Scopus, and Elsevier, as well as search engines such as Google Scholar, with related keywords.

Results: Surgery as the last treatment method for bladder stones was first proposed in the Golden Age (800-1300AD) of Persian traditional medicine by Ali ibn Rabben Tabari (810-895 AD) and Rhazes (865-925 AD), who discussed it in more detail. Then Hally Abbas, Albucasis, and Avicenna completed and enriched it. Albucasis's role is imposing due to his unique techniques in perineal cystolithotomy, forceps to extract bladder stones, and primary lithotrity until the nineteenth century.

Conclusion: Examining the evolution and progress of bladder stone treatment shows the efforts of physicians in different medical schools. The brilliance of the sages of Persian Medicine, who invented seven different types of bladder stone surgery, improved the techniques of the predecessors and created a significant leap in the progress of this surgery.

Pleuropulmonary blastoma (PPB) is a very rare tumor of the chest seen predominantly in young children with great heterogeneity and clinical, biochemical, and biological complexity and recognized, described, and classified as distinct from the pulmonary blastoma typically encountered in adults. Unfortunately, it has a poor and dismal prognosis and is mainly classified as cystic (type 1), mixed type (type 2), and solid (type 3). Herein, we present one case of PPB type 2 presenting clinically with a right pulmonary abscess, a rare clinical presentation of PPB, which was initially treated with surgery, and after approximately 1 year of follow-up, pulmonary rest-recurrence and central nervous system secondary deposits were detected. When a large pleural-based mass is identified in a young child, PPB should also be considered, especially in a patient with a positive oncological family history. Suggestive findings include the absence of chest wall invasion, presence of pleural fluid, right-sided location, and heterogeneous native (NECT) low attenuation with variable postcontrast enhancement. The authors believe that a modern therapeutic approach should consider these results for a better understanding of the genetic nature and complex mechanism and process of PPB disease development (both clinical and preclinical data concerning PPB pathophysiology are still lacking and are not completely understood) so that it would be possible to establish new possible therapeutic options (i.e. nuclear medicine theranostics in PPB treatment, developments and innovation in FLASH radiotherapy and proton therapy) and approaches, and so that, given the severity of the disease, it would be possible to indicate the importance of genetic testing and counseling of close relatives. In line with the previous, the rapid development of artificial intelligence could potentially bring the development of a novel fusion of radio mics and semantic features and MRI-based machine learning in distinguishing PPB from similar pathology.

Objective: Thyroid-originated paragangliomas are very uncommon, and there is a lack of established guidelines regarding their management.

Methods: A case study was presented, and a review of the literature was conducted.

Results: Diagnosing a paraganglioma requires multiple diagnostic methods, including a 24-h measurement of metanephrines or catecholamines, anatomical imaging using magnetic resonance or computed tomography (CT) scans, and functional imaging using metaiodobenzylguanidine or ¹⁸F-DOPA PET/CT scans. Additionally, with the presence of somatostatin receptors on paragangliomas, the use of octreotide scans such as a ⁶⁸Ga DOTATATE PET/CT scan is expected to increase soon. The primary treatment for laryngeal paragangliomas is surgical intervention aimed at achieving optimal tumor removal while retaining the highest possible level of laryngeal function. One should not do elective neck dissection given the low risk of metastasis and recurrence. Although the rate of recurrence and metastasis for paragangliomas is low, continued monitoring through clinic visits, biochemical testing, and imaging is still necessary. Furthermore, follow-up efforts should also consider genetic testing of the critical genes associated with paragangliomas.

Conclusion: Although there is still debate regarding the existence of thyroid paraganglioma, it can nonetheless be classified as a subtype of laryngeal paragangliomas. All hypervascular thyroid nodules require the consideration of thyroid-associated paragangliomas.

Aim: In this technical note we describe a simplified totally transabdominal technique to perform a single stapled end-to-end colorectal anastomosis without the need for transanal transection, linear stapler line resection, purse string or dog-ear suturing.

Method: The rationale and the technique itself are first explained by using a schematic design. Next, step-by-step pictures of one of our cases show the feasibility and advantages of this technique. At the end, the limits of this technique are illustrated.

Results: The technique was used for 20 colorectal anastomosis, 9 benign and 11 oncological cases. Median age was 68 years and average BMI was 28 kg/m². Risk factors for anastomotic leakage were reported in 10 cases. The bow tie technique was performed in every case and the linear stapler line was entirely resected in all cases. No positive air leak test or anastomotic leakage was reported.

Conclusions: The bow tie technique is a feasible technique to perform an end-to-end single stapled colorectal anastomosis with promising results on anastomotic leakage. Further research with larger prospective data collection is necessary to validate this technique and show its potential benefit on anastomotic leakage.

Objective: Rib fractures are common in thoracic trauma patients. There are various factors, including flail chest, pulmonary contusion, and accompanying conditions, affecting morbidity and mortality. The study aimed to identify high-risk patients for morbidity and mortality with a scoring system that the authors created.

Methods: Cases over the age of 18 admitted due to trauma and diagnosed with rib fractures between 1 January 2019 and 1 March 2023, were included. Trauma scores were determined by applying the new trauma scoring system. Trauma scores and other variables regarding morbidity and mortality were evaluated.

Results: A total of 1023 cases were included in the study. The total trauma scores were higher in bilateral and multiple fractures. In those without respiratory failure, the total score was statistically significantly lower than in the groups with respiratory failure. The total score was significantly higher in those who needed surgery, those who were hospitalized, and those who needed intensive care compared to the non-surgical groups. However, there was no correlation between intensive care unit stay and total score. Trauma mechanism, presence of additional extrathoracic pathology, and thoracic trauma-age score were independent predictors of survival.

Conclusion: The present study demonstrated that the number of rib fractures and the presence of pulmonary contusion did not have an effect on mortality and morbidity. The presence of extrathoracic pathology and age significantly affect survival.

Background: History has paid little attention to the childbirth of Marie Louise, second wife to the Emperor Napoleon I. Most historians state that the obstetrician Antoine Dubois needed to use his forceps during a difficult breech delivery. As practicing obstetricians we aimed to reconstruct the likely course of events using a forensic approach.

Methods: We have consulted historical documents and key witness accounts as primary sources. We have followed the clinical guidance of the 1807 edition of 'l'Art des Accouchemens'. We have tested a new hypothesis of the possible course of the childbirth through a simulation using the Assisted Vaginal Birth Module PROMPT Flex CDE® as an obstetrical model and an authentic Levret forceps.

Discussion: A transverse lie with hip presentation is the most plausible diagnosis of the foetal malposition that complicated the delivery of Marie Louise by Antoine Dubois. The long duration of the delivery of the entrapped foetal head and the insistence on the presence of his colleague Corvisart by Antoine Dubois can be explained through our hypothesis that the occiput of the entrapped foetal head was very likely in a transverse position. The seemingly impossible application of a forceps in this position, had already been described in the nineteenth century both in France and outside.

Conclusion: Our simulation confirmed the practicability of the application of the forceps as assumed by our hypothesis. Definitive proof that this scenario actually happened, cannot be given because there are no written first-hand accounts by Dubois on the delivery.

Background: The primary surgical approach for removing adrenal masses is minimally invasive adrenalectomy. Recognition of anatomical landmarks during surgery is critical for minimizing complications. Artificial intelligence-based tools can be utilized to create real-time navigation systems during laparoscopic and robotic right adrenalectomy. In this study, we aimed to develop deep learning models that can identify critical anatomical structures during minimally invasive right adrenalectomy.

Methods: In this experimental feasibility study, intraoperative videos of 20 patients who underwent minimally invasive right adrenalectomy in a tertiary care center between 2011 and 2023 were analyzed and used to develop an artificial intelligence-based anatomical landmark recognition system. Semantic segmentation of the liver, the inferior vena cava (IVC), and the right adrenal gland were performed. Fifty random images per patient during the dissection phase were extracted from videos. The experiments on the annotated images were performed on two state-of-the-art segmentation models named SwinUNETR and MedNeXt, which are transformer and convolutional neural network (CNN)-based segmentation architectures, respectively. Two loss function combinations, Dice-Cross Entropy and Dice-Focal Loss were experimented with for both of the models. The dataset was split into training and validation subsets with an 80:20 distribution on a patient basis in a 5-fold cross-validation approach. To introduce a sample variability to the dataset, strong-augmentation techniques were performed using intensity modifications and perspective transformations to represent different surgery environment scenarios. The models were evaluated by Dice Similarity Coefficient (DSC) and Intersection over Union (IoU) which are widely used segmentation metrics. For pixelwise classification performance, accuracy, sensitivity and specificity metrics were calculated on the validation subset.

Results: Out of 20 videos, 1000 images were extracted, and the anatomical landmarks (liver, IVC, and right adrenal gland) were annotated. Randomly distributed 800 images and 200 images were selected for the training and validation subsets, respectively. Our benchmark results show that the utilization of Dice-Cross Entropy Loss with the transformer-based SwinUNETR model achieved 78.37%, whereas the CNN-based MedNeXt model reached a 77.09% mDSC score. Conversely, MedNeXt reaches a higher mIoU score of 63.71% than SwinUNETR by 62.10% on a three-region prediction task.

Conclusion: Artificial intelligence-based systems can predict anatomical landmarks with high performance in minimally invasive right adrenalectomy. Such tools can later be used to create real-time navigation systems during surgery in the near future.

Background: Despite the increasing use of robotic gastrectomy (RG) as an alternative to laparoscopic gastrectomy (LG) in treating gastric cancer, controversy remains over the advantages of RG compared to LG and there is a paucity of studies comparing the two techniques regarding patient survival.

Methods: In this retrospective cohort study, 675 patients undergoing minimally invasive gastrectomy were recruited from January 2016 to January 2018 (LG: n = 567; RG: n = 108). A one-to-one propensity score matching (PSM) analysis was applied to minimize the selection bias due to confounding factors, yielding 104 patients in each of the RG and LG groups. After matching, the short-term outcomes and 3-year overall survival were compared in the two groups.

Results: The PSM cohort analysis showed a similar 3-year overall survival between RG and LG groups (p = .249). Concerning the short-term outcomes, the RG compared to LG resulted in lower blood loss (p = .01), lower postoperative complications (p = .001), lower postoperative pain (p = .016), earlier initiation of soft diet (p = .011), shorter hospital stay ‌(p = .012), but higher hospitalization expenses (p = .001).

Conclusion: Our findings suggest that RG may offer advantages in terms of blood loss, surgical complications, recovery time, and pain management compared to LG while maintaining similar overall survival rates. However, RG is associated with higher hospital costs, potentially limiting its wider adoption. Further research, including large, multi-center randomized controlled trials with longer patient follow-up, particularly for advanced gastric cancer, is needed to confirm these findings.

Introduction: We present a case of a patient with resectable perihilar cholangiocarcinoma (pCCA) who underwent primary metal stenting above the ampulla, followed by a successful surgical resection. Biliary drainage is a crucial step in the preoperative management of pCCA, yet there is no consensus on the optimal approach. Traditional drainage methods involve passing through the ampulla and/or the skin barrier, thereby increasing the risk of bacterial contamination of the biliary tree and secondary cholangitis.

Method: A novel drainage technique was utilised in this case. A metal stent was percutaneously placed across the malignant hilar stenosis without external biliary drainage. During the procedure, both guidewires and stents were meticulously prevented from passing through the ampulla. Additionally, percutaneous access to the biliary tree was removed during the index procedure to minimise the risk of biliary colonisation and cholangitis.

Results: Following the drainage, bilirubin levels rapidly normalised, and no clinical or biochemical signs of cholangitis were observed. This allowed for rapid and uncomplicated surgical resection.

Conclusion: This case illustrates the potential of a novel biliary drainage technique in patients with pCCA. By minimising the risk of biliary colonisation and cholangitis, this approach could potentially improve surgical outcomes.

Introduction: Sleeve gastrectomy is a common bariatric procedure to manage morbid obesity. Splenic injury such as splenic rupture after sleeve gastrectomy is a rare complication which can be treated both with a splenectomy or conservative approach, called spleen-preserving surgery.

Patients and methods: A 42-year old male, in whom we performed a sleeve gastrectomy, presented with splenic rupture, within 48 h postoperative, for which spleen-preserving surgery was performed. As splenic rupture is a very rare complication, we performed an extensive literature search in the PubMed database. After obtaining patient informed consent, we aim to describe a sixth presentation of this rare surgical complication.

Result: To the best of our knowledge, only five cases of splenic rupture after laparoscopic sleeve gastrectomy have been described before, all treated with a splenectomy. Furthermore, we are the first to describe spleen-preserving surgery.

Conclusion: We present the sixth case of spontaneous splenic rupture after laparoscopic sleeve gastrectomy, and the first to treat it with spleen-preserving surgery.