Acta Chirurgica Belgica最新文献

Background: The risks and benefits of preoperative aspirin continuation in patients undergoing isolated heart valve replacement surgery are unclear. We investigated the effect of aspirin continuation on the risk of bleeding and transfusion in these patients.

Methods: In this single center, retrospective study, among 474 adult patients who underwent isolated heart valve surgery between April 2013 and June 2018, 269 continued aspirin within 5 days before surgery (aspirin group) and 205 patients did not take or stopped aspirin no later than 5 days before surgery (non-aspirin group). The chi-square test, the Mann-Whitney U-test, and the Student's T-test were used to compare data between the groups. Univariate and Multivariate logistic regressions were used to assess crude and adjusted relationships between outcome and exposure.

Results: The primary outcome, red blood cell (RBC) transfusion, occurred in 59 patients (22%) of the aspirin group and in 24 patients (12%) of the non-aspirin group (p = 0.004). After adjustment for confounding factors, continuation of aspirin was no longer associated with RBC transfusion (aOR1.8;95%CI,0.98-3.2;p = 0.06). The amount of allogenic blood products, the incidence of surgical re-exploration for bleeding, the volume of re-transfused cell-saved blood, and the cumulative chest tube drainage during the first 24 postoperative hours were similar between groups.

Conclusion: Preoperative continuation of aspirin in patients undergoing isolated heart valve surgery is neither associated with a higher incidence of RBC transfusion, nor with larger perioperative blood loss, or more frequent surgical revision for bleeding.

Trial registration: Clinicaltrials.gov (NCT05151796).

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.

Background: Displaced posterior segmental bronchus (B²) accompanied by anomalous pulmonary vessels is a very rare condition. There is a risk of unexpected injuries to bronchi and blood vessels when patients with such anomalies undergo surgery for lung cancer, especially thoracoscopic surgery.

Methods: We reported a case of thoracoscopic right upper lobectomy in a patient with a displaced B² and pulmonary vascular variation.

Results: A 74-year-old woman was admitted to our hospital with a 2.2 cm × 2.1 cm nodule in the right lung. Three-dimensional computed tomography (3D-CT) revealed the combined apical/anterior segmental branch (B^1 + 3) taken off the beginning of the right main bronchus (RMB), at the level of the carina. The displaced B² taken off the end of the RMB. The anomalous central vein (CV), which passed between B² and B^1 + 3, ran dorsal to the main pulmonary artery (MPA) and directly into the left atrium. The patient consequently underwent uniportal thoracoscopic right upper lobectomy and mediastinal lymph node dissection. The intraoperative findings were completely consistent with 3D-CT.

Conclusions: This paper reports a case of a displaced B² combined with right upper pulmonary vessels malformation. Under the guidance of 3D-CT, the right upper lobectomy was successfully completed by single hole thoracoscopic surgery.

Introduction: Cystic adventitial disease (CAD) is an uncommon condition that affects arteries and veins. It can cause a rare type of non-atherosclerotic peripheral vessel disease. The most common vessel affected is the popliteal artery. The number of case reports on CAD of the femoral artery is growing. We present a case of a 62-year-old female presented with claudication of the left leg diagnosed with CAD of the left common femoral artery. The patient was treated surgically with cyst excision and vessel reconstruction with saphenous vein autograft patch plasty. After 8-months the cyste relapsed and she had new claudication complains. We decided to perform new surgery. Surgical treatment consisted of cyst resection by excision of the femoral bifurcation and saphenous vein autograft interposition reconstruction of the bifurcation. We also provide an update on the latest literature of surgical treatment of CAD of the ilio-femoral artery region.

Methods: Medline and EMBASE were used to collect articles on CAD of ilio-femoral artery. We included English written or translated case reports or series between 1987 and 2023.

Results: Twenty-nine patients out of 28 case reports were included. Most patients were male (59%). Claudication is the most common symptom (76%). Treatment consisted of cyst resection, cyst decompression, Endarterectomy, patch angioplasty and interposition graft using PTFE, Dacron, Great saphenous vein (GSV) or femoral vein autograft. Recurrence appeared in 4 cases (14%).

Conclusion: In accordance to the literature and our experience we recommend complete vessel excision and saphenous vein (or PTFE) interposition bypass as treatment.

Background: Surgical injury induces a stress response to surgery that induces tissue repair with the activation of endocrine, metabolic, and immunological mediators aimed at restoring hemostasis.

Objective: In our study to determine the effect of analgesic method on postoperative respiratory function tests, stress hormone and proinflammatory response in patients undergoing elective thoracotomy surgery.

Methods: Seventy-two patients aged between 18 and 75 years with scheduled for elective thoracotomy surgery were included in the study. Thirty-six patients who underwent Erector Spinae Plane block were included in the block group, and 36 patients were included in the control group. IL 6, TNF alpha, cortisol, CRP, insulin and blood glucose levels were measured preoperatively, at the 3rd hour after postoperative extubation and at the 24th postoperative hour.

Results: We observed that while IL6 and TNF alpha levels decreased in the ESPB group compared to the preoperative period, they increased insignificantly in the control group.

Conclusion: ESPB has a positive effect on stress hormones and proinflammatory cytokines, reduces the use of opioids and analgesics in the intraoperative and postoperative period compared to patients without block, and lower VAS scores are obtained in patients with block.

Background: Queen Christina of Sweden, a prominent Early Modern European character, died in Rome on April 19th, 1689. The scarce literature published about her illness and death agrees about the cause of the death in the diagnosis of erysipelas, that did not appear externally with an ulcer, but became manifest in her blood, causing an inflammation of heart and lungs. The article underlines the essential contribution of the learned surgeons to the development of practical anatomy in the late Seventeenth century as illustrated by the specific case of the Queen's autopsy report by the court surgeon Alessio Spalla.

Methods: The study is based on the analysis of the published literature and the comparison of archival sources as the anonymous report of the Queen's autopsy, preserved in Vienna and the unknown autopsy by Spalla, discovered in a private archive.

Results: The comparison of Spalla's autopsy with the Viennese report of an anonymous practical doctor -suspected to be Marcello Malpighi-, who also participated in the Queen's dissection highlights how the two perspectives of investigation - the surgical-morphological and the medical-practical ones - are integrated in the theoretical and practical dimension of practical anatomy.

Conclusions: The unpublished report of the surgeon Spalla integrates the knowledge of the queen's illness and death, stands as an example of a private autopsy performed by a court surgeon in the late Seventeenth-century Rome and as a case study on the development of new hybrid areas of knowledge, such as practical anatomy.

Introduction: Malign peritoneal mesothelioma (MPM) is an uncommon disease that is difficult to treat. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) are the gold standards for treating MPM. Sometimes extreme cytoreductive surgery (eCRS) is required to achieve complete cytoreduction, which is one of the most important prognostic factors. There is limited information in the literature about the contribution of eCRS in patients with MPM. In this study, we aimed to investigate the impact of eCRS on survival and perioperative outcomes.

Methods: The Department of Surgical Oncology at Cumhuriyet University database was retrospectively reviewed for MPM patients who underwent CRS-HIPEC between January 2004 and December 2018. Patients who underwent CRS-HIPEC were divided into eCRS and less extensive CRS (leCRS) groups. A resection of ≥5 organs or ≥3 small bowel anastomoses were defined as eCRS. Both groups were compared regarding survival, demographic information, and perioperative outcomes.

Results: A total of 31 patients were included. eCRS-HIPEC was used in 15 patients. Complete cytoreduction (CC score 0/1) was achieved in all 31 patients. Compared to leCRS, the eCRS group had a longer median length of stay, longer intensive care unit stay, a higher median peritoneal cancer index (PCI), higher intraoperative blood loss, more frequent occurrence of any complication, and a longer operative time (all p values < 0.001). Clavien Dindo 3-4 complications, ASA, and gender were similar in both groups of patients (p > 0.05). It was found that there was no significant difference between the OS of the eCRS and leCRS groups (37.5 vs. 42.8 months, p = 0.895).

Conclusions: Rates of serious complications and morbidity are similar in patients undergoing eCRS compared to leCRS. In patients with high PCI and multiorgan involvement, complete cytoreduction can be achieved by performing eCRS, and survival results equivalent to those with low PCI can be achieved.

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.

Background: The diagnosis and treatment of spine disorders have been challenging for thousands of years in different nations and medical schools. Despite this long history, there are many information gaps in this regard. The current research deals with the milestones and progress of spine surgery from ancient times until now, emphasizing the innovations of sages in the Persian traditional medicine era.

Methods: The present study is based on searching original and library documents, data from databases such as PubMed, Scopus, and Science Direct, and search engines such as Google Scholar.

Results: In Persian traditional medicine, Rhazes (865-925 AD) was the first sage who applied spine surgery based on the innovative knowledge of Galen (second century AD) and Paulus Aegineta (seventh century AD). Hally Abbas (tenth century AD), by suturing two separated bones during spine surgery, and Albucasis (936-1013 AD), by inventing, describing, and drawing the surgical instruments involved in surgeries in this area, and also using cauterization in the treatment of children's hunchback, were the innovators of new methods.

Conclusion: The modern knowledge of spine surgery is based on intelligent experiences and prominent thoughts from thousands of years worldwide. However, sometimes, these key points have remained hidden. This issue necessitates investigating this science in different schools and territories for comparative studies, identifying the firsts in the prominent points of this field, preserving the identity of sages and nations, and preventing scientific plagiarism.