Introduction: Breast cancer is one of the most common malignancies, treated with primary surgery, or surgery after neoadjuvant chemotherapy. Many studies indicate that the peri-operative period is critical as interference with the immune system may affect prognosis. Whether certain anesthetic agents can affect the immune response and cancer progression is still unresolved. Evidence acquisition: In the current study, we review the existing clinical and experimental studies, in an attempt to extract useful information for clinical application in the anesthesia practice for patients treated with surgery for breast cancer. A bibliographic search in PubMed and ScienceDirect related to the effects of anesthesia on cancer progression and anti-tumor immunity, published from January 2000 till today was performed. Evidence synthesis: All included studies were gathered in a list and they were analysed. A total of 34 studies were found relevant to the subject in PubMed and ScienceDirect. Conclusion: The overall experience suggests that the peri-operative management of cancer patients should focus on the reduction of surgical stress, the minimization of the use of opioids, and the adoption of regional anesthetics. This could have an impact on anti-tumour immunity and the outcome of cancer patients.
{"title":"The effects of anesthesia on cancer progression and anti-tumor immunity. A review","authors":"lyronis Grigorios, Efremidou Eleni, Zachou Maria-Eleni, Kaprana Antigoni, Koukourakis Michael, Chloropoulou Pelagia","doi":"10.17352/2455-2968.000161","DOIUrl":"https://doi.org/10.17352/2455-2968.000161","url":null,"abstract":"Introduction: Breast cancer is one of the most common malignancies, treated with primary surgery, or surgery after neoadjuvant chemotherapy. Many studies indicate that the peri-operative period is critical as interference with the immune system may affect prognosis. Whether certain anesthetic agents can affect the immune response and cancer progression is still unresolved. Evidence acquisition: In the current study, we review the existing clinical and experimental studies, in an attempt to extract useful information for clinical application in the anesthesia practice for patients treated with surgery for breast cancer. A bibliographic search in PubMed and ScienceDirect related to the effects of anesthesia on cancer progression and anti-tumor immunity, published from January 2000 till today was performed. Evidence synthesis: All included studies were gathered in a list and they were analysed. A total of 34 studies were found relevant to the subject in PubMed and ScienceDirect. Conclusion: The overall experience suggests that the peri-operative management of cancer patients should focus on the reduction of surgical stress, the minimization of the use of opioids, and the adoption of regional anesthetics. This could have an impact on anti-tumour immunity and the outcome of cancer patients.","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":"17 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712047","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 : 2024-02-12DOI: 10.17352/2455-2968.000160
Ruiz Alberto Martínez, Bergese Sergio, Escontrela Rodríquez Blanca Anuncia, Boedo María Jesús Maroño, Gala Ane Guereca, Echeverria-Villalobos Marco
Background and objectives: Chronic hypertension has a higher incidence in the perioperative setting. It increases the risk of complications like acute hypertension, bleeding, myocardial ischemia, and stroke. Perioperative management of these patients during vascular surgery could be challenging because of the additional co-morbidities like diabetes mellitus, vasculopathy, and cardiac disease. For these reasons, we conducted a retrospective study to observe the complications and mortality associated with chronic hypertension during vascular surgery. Materials and methods: After ethical committee approval we retrospectively review medical records of patients undergone abdominal aortic aneurysm repair surgery. Age, sex, ASA physical status, chronic hypertension (controlled or uncontrolled), type of surgery (open or endovascular; scheduled or urgent), anesthesia type, postoperative complications (acute hypertension, bleeding, acute renal failure, heart failure, stroke, and cardiac arrest) and mortality were recorded. A multivariate analysis of chronic hypertension, postoperative complications, and mortality was conducted using SPSS Software. A p - value < 0.05 was considered statistically significant. Results: Our study included 544 patients undergoing abdominal aortic aneurysm repair surgery. Ninety-four percent of patients were men, mean age of 72 years old, and 67% were ASA III and IV. Seventy-three percent of patients presented chronic hypertension with appropriate control defined as the lack of target organ damage and previous complications related to hypertension in 83% of these patients. Endovascular surgery was performed in 44% and open procedure in 56% of patients. Elective surgery was carried out in 83% and urgent surgery in 17% of patients. General anesthesia was performed in 73% (combined general anesthesia with epidural analgesia in 36%) and regional anesthesia in 27% of cases. Controlled chronic hypertension was not associated with postoperative complications (CI 95% 0,581-2,982 p 0,510) and mortality (1-year mortality CI 95% 0,786-5,240 p 0,144; 2-year mortality CI 95% 0,655-3,845 p 0,306). Discussion: Chronic hypertension is largely considered a risk factor for perioperative complications of AAA repair. Conversely, our results suggest that adequate control of chronic hypertension before AAA repair leads to a low incidence of postoperative complications as well as 1 and 2-year mortality rates.
背景和目的：慢性高血压在围手术期的发病率较高。它会增加急性高血压、出血、心肌缺血和中风等并发症的风险。由于合并糖尿病、血管病变和心脏病等其他疾病，在血管手术期间对这些患者进行围手术期管理可能具有挑战性。因此，我们进行了一项回顾性研究，以观察血管手术中与慢性高血压相关的并发症和死亡率。材料和方法：经伦理委员会批准后，我们回顾性审查了接受腹主动脉瘤修补手术患者的病历。记录了年龄、性别、ASA 身体状况、慢性高血压（已控制或未控制）、手术类型（开腹或血管内手术；计划或紧急）、麻醉类型、术后并发症（急性高血压、出血、急性肾功能衰竭、心力衰竭、中风和心脏骤停）和死亡率。使用 SPSS 软件对慢性高血压、术后并发症和死亡率进行了多变量分析。P 值小于 0.05 视为具有统计学意义。结果我们的研究包括 544 名接受腹主动脉瘤修补手术的患者。94%的患者为男性，平均年龄为72岁，67%为ASA III级和IV级。73%的患者患有慢性高血压，其中83%的患者病情得到了适当控制，即没有靶器官损伤和与高血压相关的既往并发症。44%的患者接受了血管内手术，56%的患者接受了开放手术。83%的患者进行了择期手术，17%的患者进行了紧急手术。73%的患者进行了全身麻醉（36%的患者结合硬膜外镇痛进行全身麻醉），27%的患者进行了区域麻醉。控制慢性高血压与术后并发症（CI 95% 0,581-2,982 p 0,510）和死亡率（1 年死亡率 CI 95% 0,786-5,240 p 0,144；2 年死亡率 CI 95% 0,655-3,845 p 0,306）无关。讨论慢性高血压在很大程度上被认为是导致 AAA 修复术围手术期并发症的危险因素。相反，我们的研究结果表明，在 AAA 修复术前充分控制慢性高血压可降低术后并发症的发生率以及 1 年和 2 年的死亡率。
{"title":"Chronic hypertension in infrarenal abdominal aortic aneurysm repair surgery. Multivariate analysis","authors":"Ruiz Alberto Martínez, Bergese Sergio, Escontrela Rodríquez Blanca Anuncia, Boedo María Jesús Maroño, Gala Ane Guereca, Echeverria-Villalobos Marco","doi":"10.17352/2455-2968.000160","DOIUrl":"https://doi.org/10.17352/2455-2968.000160","url":null,"abstract":"Background and objectives: Chronic hypertension has a higher incidence in the perioperative setting. It increases the risk of complications like acute hypertension, bleeding, myocardial ischemia, and stroke. Perioperative management of these patients during vascular surgery could be challenging because of the additional co-morbidities like diabetes mellitus, vasculopathy, and cardiac disease. For these reasons, we conducted a retrospective study to observe the complications and mortality associated with chronic hypertension during vascular surgery. Materials and methods: After ethical committee approval we retrospectively review medical records of patients undergone abdominal aortic aneurysm repair surgery. Age, sex, ASA physical status, chronic hypertension (controlled or uncontrolled), type of surgery (open or endovascular; scheduled or urgent), anesthesia type, postoperative complications (acute hypertension, bleeding, acute renal failure, heart failure, stroke, and cardiac arrest) and mortality were recorded. A multivariate analysis of chronic hypertension, postoperative complications, and mortality was conducted using SPSS Software. A p - value < 0.05 was considered statistically significant. Results: Our study included 544 patients undergoing abdominal aortic aneurysm repair surgery. Ninety-four percent of patients were men, mean age of 72 years old, and 67% were ASA III and IV. Seventy-three percent of patients presented chronic hypertension with appropriate control defined as the lack of target organ damage and previous complications related to hypertension in 83% of these patients. Endovascular surgery was performed in 44% and open procedure in 56% of patients. Elective surgery was carried out in 83% and urgent surgery in 17% of patients. General anesthesia was performed in 73% (combined general anesthesia with epidural analgesia in 36%) and regional anesthesia in 27% of cases. Controlled chronic hypertension was not associated with postoperative complications (CI 95% 0,581-2,982 p 0,510) and mortality (1-year mortality CI 95% 0,786-5,240 p 0,144; 2-year mortality CI 95% 0,655-3,845 p 0,306). Discussion: Chronic hypertension is largely considered a risk factor for perioperative complications of AAA repair. Conversely, our results suggest that adequate control of chronic hypertension before AAA repair leads to a low incidence of postoperative complications as well as 1 and 2-year mortality rates.","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":"309 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140458523","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 : 2023-11-25DOI: 10.17352/2455-2968.000157
Touati Med Dheker, Idani Marwa, Ben Othmane Mohamed Raouf, Khefacha Fahd, Khelifi Nadhem, Belhadj Anis, Saidani Ahmed, Chebbi Faouzi
Gastrointestinal stromal tumors originating from the small bowel are uncommon. We present the case of a 45-year-old man with no prior medical or surgical history who presented to our hospital's emergency department with abdominal pain, vomiting, inability to pass gas, and no bowel movements. Physical examination revealed abdominal distention and tenderness. His white blood cell count was 10.9 x 10^3/µl, and hemoglobin levels were 13.3 g/dl.
源于小肠的胃肠道间质瘤并不常见。本院急诊科收治了一例 45 岁男性患者，无内科或外科病史，因腹痛、呕吐、无法排气、无大便而就诊。体格检查发现他腹部胀痛。他的白细胞计数为 10.9 x 10^3/µl，血红蛋白水平为 13.3 g/dl。
{"title":"Gastrointestinal Stromal Tumor (GIST) presenting as acute abdomen: Image in surgery","authors":"Touati Med Dheker, Idani Marwa, Ben Othmane Mohamed Raouf, Khefacha Fahd, Khelifi Nadhem, Belhadj Anis, Saidani Ahmed, Chebbi Faouzi","doi":"10.17352/2455-2968.000157","DOIUrl":"https://doi.org/10.17352/2455-2968.000157","url":null,"abstract":"Gastrointestinal stromal tumors originating from the small bowel are uncommon. We present the case of a 45-year-old man with no prior medical or surgical history who presented to our hospital's emergency department with abdominal pain, vomiting, inability to pass gas, and no bowel movements. Physical examination revealed abdominal distention and tenderness. His white blood cell count was 10.9 x 10^3/µl, and hemoglobin levels were 13.3 g/dl.","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139236676","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 : 2023-11-17DOI: 10.17352/2455-2968.000156
Touati Med Dheker, Ben Othmane Mohamed Raouf, Khefacha Fahd, Khelifi Nadhem, Belhadj Anis, Saidani Ahmed, Chebbi Faouzi
Omental Infarction (OI) is a rare condition that can mimic common causes of acute abdominal pain, primarily affecting individuals aged 40 to 50, with a male predominance. Imaging techniques like ultrasound and computed tomography aid in diagnosis. Treatment options range from conservative management to surgery, depending on severity and complications. OI often leads to right-sided abdominal pain in 90% of cases, with histological features including focal necrosis and fibroblastic reactions. Acute appendicitis is a common cause of acute abdominal conditions, especially in children and adolescents. Having a patient simultaneously presenting with acute appendicitis and omental infarction is extremely rare, with only three cases reported in the literature to date to our knowledge. We present the case of a 32-year-old male, a heavy smoker, who presented with epigastric pain and vomiting. Initial clinical suspicion was a perforated ulcer, but imaging revealed swollen appendicitis with adjacent fat stranding and evidence of epiploic infarction near the stomach. Laparoscopic surgery confirmed the diagnosis of acute appendicitis, with an appendectomy performed and identification of the infarcted omentum, which was preserved. After the operation, the patient had a successful recovery and was discharged on the second postoperative day. This case firstly emphasizes the rarity of the association between acute appendicitis and omental infarction in the same patient and underscores the importance of considering Omental Infarction (OI) in the differential diagnosis of acute abdominal pain. Imaging plays a crucial role in accurate diagnosis, and a high degree of suspicion and prompt diagnosis are crucial for optimal patient outcomes.
{"title":"A rare occurrence: A case report of acute appendicitis and omental infarction unveiled by epigastric pain in a heavy smoker","authors":"Touati Med Dheker, Ben Othmane Mohamed Raouf, Khefacha Fahd, Khelifi Nadhem, Belhadj Anis, Saidani Ahmed, Chebbi Faouzi","doi":"10.17352/2455-2968.000156","DOIUrl":"https://doi.org/10.17352/2455-2968.000156","url":null,"abstract":"Omental Infarction (OI) is a rare condition that can mimic common causes of acute abdominal pain, primarily affecting individuals aged 40 to 50, with a male predominance. Imaging techniques like ultrasound and computed tomography aid in diagnosis. Treatment options range from conservative management to surgery, depending on severity and complications. OI often leads to right-sided abdominal pain in 90% of cases, with histological features including focal necrosis and fibroblastic reactions. Acute appendicitis is a common cause of acute abdominal conditions, especially in children and adolescents. Having a patient simultaneously presenting with acute appendicitis and omental infarction is extremely rare, with only three cases reported in the literature to date to our knowledge. We present the case of a 32-year-old male, a heavy smoker, who presented with epigastric pain and vomiting. Initial clinical suspicion was a perforated ulcer, but imaging revealed swollen appendicitis with adjacent fat stranding and evidence of epiploic infarction near the stomach. Laparoscopic surgery confirmed the diagnosis of acute appendicitis, with an appendectomy performed and identification of the infarcted omentum, which was preserved. After the operation, the patient had a successful recovery and was discharged on the second postoperative day. This case firstly emphasizes the rarity of the association between acute appendicitis and omental infarction in the same patient and underscores the importance of considering Omental Infarction (OI) in the differential diagnosis of acute abdominal pain. Imaging plays a crucial role in accurate diagnosis, and a high degree of suspicion and prompt diagnosis are crucial for optimal patient outcomes.","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":"44 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139264388","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 : 2023-11-04DOI: 10.17352/2455-2968.000155
Altieri Michele, Giacomelli F, Anselmi L
Moll glands are sweat apocrine glands close to the eyelid margin. Tumors derived from Moll glands are rare, although Moll glands cysts are frequent. They originate from their glandular tissue or tubules. In this report we present a rare case of a lower eyelid skin tubular apocrine adenoma occurred in the right eye lower eyelid of a caucasian 45 year old woman. The lesion was nodular and dome shaped and its size was 1.5 × 3.5 × 2 mm. After a complete excision the lesion was analyzed by our pathology unit. Histologic sections were stained with haematoxylin and eosin, alcian blue, periodic acid-Schiff (PAS). Additionally, the following immunohistochemical markers were used: cytokeratin 7 (CK7), cytokeratin 8/18 (CK8/18), cytokeratin 20 (CK20), S-100 protein and gross cystic disease protein 15 (GCDFP-15) (4,5). The immunohistochemical and phenotypic features resulted suggest the diagnosis of lower eyelid tubular apocrine adenoma probably originated from Moll glands. These findings allowed us to diagnose a very rare and benign cutaneous lesion of eyelid skin.
{"title":"A case report of tubular apocrine adenoma of lower eyelid","authors":"Altieri Michele, Giacomelli F, Anselmi L","doi":"10.17352/2455-2968.000155","DOIUrl":"https://doi.org/10.17352/2455-2968.000155","url":null,"abstract":"Moll glands are sweat apocrine glands close to the eyelid margin. Tumors derived from Moll glands are rare, although Moll glands cysts are frequent. They originate from their glandular tissue or tubules. In this report we present a rare case of a lower eyelid skin tubular apocrine adenoma occurred in the right eye lower eyelid of a caucasian 45 year old woman. The lesion was nodular and dome shaped and its size was 1.5 × 3.5 × 2 mm. After a complete excision the lesion was analyzed by our pathology unit. Histologic sections were stained with haematoxylin and eosin, alcian blue, periodic acid-Schiff (PAS). Additionally, the following immunohistochemical markers were used: cytokeratin 7 (CK7), cytokeratin 8/18 (CK8/18), cytokeratin 20 (CK20), S-100 protein and gross cystic disease protein 15 (GCDFP-15) (4,5). The immunohistochemical and phenotypic features resulted suggest the diagnosis of lower eyelid tubular apocrine adenoma probably originated from Moll glands. These findings allowed us to diagnose a very rare and benign cutaneous lesion of eyelid skin.","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139289571","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 : 2023-01-19DOI: 10.17352/2455-2968.000154
Alotaibi Fahad E
Objective: Various endoscopically assisted minimally invasive surgical procedures have been described for the management of isolated nonsyndromic sagittal synostosis. All these techniques necessitate the use of postoperative helmets without immediate correction of the head shape. Here, we document the safety and sustainable acceptable outcomes of an endoscopic minimally invasive approach with full barrel staving without using a postoperative cranial helmet. Methods: A single-institution cohort analysis was performed on five patients who underwent endoscopically assisted minimally invasive calvarial vault remodeling without using a postoperative helmet for isolated nonsyndromic sagittal synostosis between 2017 and 2022. Variables analyzed were age at the time of surgery, gender, Estimated Blood Loss (EBL), operative time, postoperative complications, and pre-and postoperative Cephalic Index (CI). Results: Three male and two female infants were treated at our hospital in 2017–2022 with a mean follow-up of 32.6 months. At the time of the surgery, the mean age was ±3.5 months (range 10–58 months), the mean weight was 4.54 kg (standard deviation, SD ± 1.56), the mean EBL was 34.6 ml (range 20 ml – 54 ml) and mean surgical time from skin incision to dressing application was 120.7 min. The mean CI for all patients was 66.88 ± 4 (SD) preoperatively vs. 81.52 ± 2.38 (SD) postoperatively (p < 0.001 by paired Student’s t - test). There were no deaths or intraoperative complications. Conclusions: We present a novel endoscopically assisted minimally invasive procedure without using a postoperative helmet. This was a safe and efficacious procedure for isolated sagittal craniosynostosis, with improvements in CI at a mean follow-up of 32.6 months.
{"title":"Endoscopic-assisted calvarial vault remodeling without postoperative helmets for treating infants with sagittal synostosis","authors":"Alotaibi Fahad E","doi":"10.17352/2455-2968.000154","DOIUrl":"https://doi.org/10.17352/2455-2968.000154","url":null,"abstract":"Objective: Various endoscopically assisted minimally invasive surgical procedures have been described for the management of isolated nonsyndromic sagittal synostosis. All these techniques necessitate the use of postoperative helmets without immediate correction of the head shape. Here, we document the safety and sustainable acceptable outcomes of an endoscopic minimally invasive approach with full barrel staving without using a postoperative cranial helmet. Methods: A single-institution cohort analysis was performed on five patients who underwent endoscopically assisted minimally invasive calvarial vault remodeling without using a postoperative helmet for isolated nonsyndromic sagittal synostosis between 2017 and 2022. Variables analyzed were age at the time of surgery, gender, Estimated Blood Loss (EBL), operative time, postoperative complications, and pre-and postoperative Cephalic Index (CI). Results: Three male and two female infants were treated at our hospital in 2017–2022 with a mean follow-up of 32.6 months. At the time of the surgery, the mean age was ±3.5 months (range 10–58 months), the mean weight was 4.54 kg (standard deviation, SD ± 1.56), the mean EBL was 34.6 ml (range 20 ml – 54 ml) and mean surgical time from skin incision to dressing application was 120.7 min. The mean CI for all patients was 66.88 ± 4 (SD) preoperatively vs. 81.52 ± 2.38 (SD) postoperatively (p < 0.001 by paired Student’s t - test). There were no deaths or intraoperative complications. Conclusions: We present a novel endoscopically assisted minimally invasive procedure without using a postoperative helmet. This was a safe and efficacious procedure for isolated sagittal craniosynostosis, with improvements in CI at a mean follow-up of 32.6 months.","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41407497","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 : 2022-12-12DOI: 10.17352/2455-2968.000153
M. Bouali, Omar El Maghraoui, Yassine Eddaoudi, Abdelilal El Bakouri, K. El Hattabi, Fatimazahra Bensardi, Abdelaziz Fadil
Claudius Amyand's hernia is defined by the incarceration of the vermicular appendix through the hernial sac. The first appendectomy was performed in 1735. It is a very rare pathology. Therefore, the frequency of this pathology is not yet established. We report the observation of a 54-year-old patient with an estimated BMI of 25.5 kg: height2 with a simple inguinal hernia that was not followed up and admitted to the emergency room with a painless and impulsive inguinal swelling when coughing. The management consisted of a conditioning and a pre-anesthetic assessment. The intraoperative exploration revealed a right inguinal hernia with caecal and appendicular contents of viable appearance. The procedure included an appendectomy and cure of the hernia using the Lichtenstein technique. The evolution was marked by a resumption of transit 24 hours postoperatively, Appendicitis complicating an Amyand's hernia is a rare pathology that often presents in an atypical clinical picture of an inguinal painful mass without the occlusive syndrome. Its preoperative radiological diagnosis, although exceptional, is of interest given the atypical presentation allowing the elimination of local pathologies that sometimes do not require emergency surgery.
{"title":"Claudius Amyand’s hernia: An uncommon form of appendicitis","authors":"M. Bouali, Omar El Maghraoui, Yassine Eddaoudi, Abdelilal El Bakouri, K. El Hattabi, Fatimazahra Bensardi, Abdelaziz Fadil","doi":"10.17352/2455-2968.000153","DOIUrl":"https://doi.org/10.17352/2455-2968.000153","url":null,"abstract":"Claudius Amyand's hernia is defined by the incarceration of the vermicular appendix through the hernial sac. The first appendectomy was performed in 1735. It is a very rare pathology. Therefore, the frequency of this pathology is not yet established. We report the observation of a 54-year-old patient with an estimated BMI of 25.5 kg: height2 with a simple inguinal hernia that was not followed up and admitted to the emergency room with a painless and impulsive inguinal swelling when coughing. The management consisted of a conditioning and a pre-anesthetic assessment. The intraoperative exploration revealed a right inguinal hernia with caecal and appendicular contents of viable appearance. The procedure included an appendectomy and cure of the hernia using the Lichtenstein technique. The evolution was marked by a resumption of transit 24 hours postoperatively, Appendicitis complicating an Amyand's hernia is a rare pathology that often presents in an atypical clinical picture of an inguinal painful mass without the occlusive syndrome. Its preoperative radiological diagnosis, although exceptional, is of interest given the atypical presentation allowing the elimination of local pathologies that sometimes do not require emergency surgery.","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42156052","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 : 2022-11-15DOI: 10.17352/2455-2968.000152
Kagaruki Tryphone Buchwald, Kivuyo Nashivai Elias, Mushi Fransia Arda, Muhamba Frank Domician, Akoko Larry Onyango
Introduction: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is excellent in predicting postoperative complications. Validation in resource-limited settings and applicability in gastrointestinal surgery is still unclear. Objective: The study aimed to determine the accuracy of the ACS-NSQIP surgical risk calculator in predicting the 30days postoperative adverse outcomes among patients who underwent laparotomy. Methods: A Single hospital-based, prospective cohort study was done at Muhimbili National Hospital in Tanzania from April 2021 to December 2021 recruiting patients aged 18 and above who underwent primary laparotomy. SR calculator variables were obtained from patients and entered manually to categorize patients into low and high-risk. Patients were followed up for thirty days for the outcome. The predicted risk was compared with actual occurrence to obtain personal risk ratios. The c-statistics of > 0.7, Brier of score < 0.25 and Index of Prediction Accuracy score were used for discrimination, accuracy, and usefulness of the model respectively. Results: ACS -NSQIP SR-Calculator discriminated well the risks of cardiac complications, re-laparotomy, Anastomotic leak, and death (c-statistic > 0.7) Poor discrimination was observed for the length of hospital stay (c-statistics 0.518). However, SR-calculator shows high calibration potential for all complications with a Brier score < 0.25 (0.002 - 0.144) and an IPA score ranging from 0.225 - 0.969. Conclusion: The ACS -NSQIP SR-calculator accurately predicted postoperative outcomes for patients requiring laparotomy. SR-Calculator is a reliable tool for preoperative shared decision-making and counseling. The model should be adopted to strengthen the healthcare system in a low-income country. What is already known about this subject? The ACS NSQIP surgical risk calculator is accurate in predicting the outcome of the Surgical procedure. ACS NSQIP surgical risk calculator was validated in the USA The SRC is associated with surgical care improvement whenever applied. What are the new findings? The SRC accurately predicted the 30-day outcomes associated with primary laparotomy except for the length of hospital stay, discharge for other services, and veno-thromboembolic events. The risk ratio (RR) provides a preliminary estimation of specific complications for a single patient. Index of prediction Accuracy (IPA) reliably summarizes the discrimination and calibration of the ACS-NSQIP-SR-Calculator. The SRC can be validated in a resource-limited setting and can be a source of surgical care improvement. How might these results affect future research or surgical practice? The results of this study will provide a comparison between our institution and other international situations where a calculator had been tested and surgical service improvement locally. Our findings will provide insights into our loco-regional surgical insti
{"title":"ACS-NSQIP – Surgical risk calculator accurately predicts outcomes of laparotomy in a prospective study at a tertiary hospital in Tanzania","authors":"Kagaruki Tryphone Buchwald, Kivuyo Nashivai Elias, Mushi Fransia Arda, Muhamba Frank Domician, Akoko Larry Onyango","doi":"10.17352/2455-2968.000152","DOIUrl":"https://doi.org/10.17352/2455-2968.000152","url":null,"abstract":"Introduction: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is excellent in predicting postoperative complications. Validation in resource-limited settings and applicability in gastrointestinal surgery is still unclear. Objective: The study aimed to determine the accuracy of the ACS-NSQIP surgical risk calculator in predicting the 30days postoperative adverse outcomes among patients who underwent laparotomy. Methods: A Single hospital-based, prospective cohort study was done at Muhimbili National Hospital in Tanzania from April 2021 to December 2021 recruiting patients aged 18 and above who underwent primary laparotomy. SR calculator variables were obtained from patients and entered manually to categorize patients into low and high-risk. Patients were followed up for thirty days for the outcome. The predicted risk was compared with actual occurrence to obtain personal risk ratios. The c-statistics of > 0.7, Brier of score < 0.25 and Index of Prediction Accuracy score were used for discrimination, accuracy, and usefulness of the model respectively. Results: ACS -NSQIP SR-Calculator discriminated well the risks of cardiac complications, re-laparotomy, Anastomotic leak, and death (c-statistic > 0.7) Poor discrimination was observed for the length of hospital stay (c-statistics 0.518). However, SR-calculator shows high calibration potential for all complications with a Brier score < 0.25 (0.002 - 0.144) and an IPA score ranging from 0.225 - 0.969. Conclusion: The ACS -NSQIP SR-calculator accurately predicted postoperative outcomes for patients requiring laparotomy. SR-Calculator is a reliable tool for preoperative shared decision-making and counseling. The model should be adopted to strengthen the healthcare system in a low-income country. What is already known about this subject? The ACS NSQIP surgical risk calculator is accurate in predicting the outcome of the Surgical procedure. ACS NSQIP surgical risk calculator was validated in the USA The SRC is associated with surgical care improvement whenever applied. What are the new findings? The SRC accurately predicted the 30-day outcomes associated with primary laparotomy except for the length of hospital stay, discharge for other services, and veno-thromboembolic events. The risk ratio (RR) provides a preliminary estimation of specific complications for a single patient. Index of prediction Accuracy (IPA) reliably summarizes the discrimination and calibration of the ACS-NSQIP-SR-Calculator. The SRC can be validated in a resource-limited setting and can be a source of surgical care improvement. How might these results affect future research or surgical practice? The results of this study will provide a comparison between our institution and other international situations where a calculator had been tested and surgical service improvement locally. Our findings will provide insights into our loco-regional surgical insti","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43459674","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 : 2022-10-04DOI: 10.17352/2455-2968.000151
Akbiyik Fatih
Background: The diagnosis and treatment of individuals with Disorders of Sexual Development is a complex process and requires a multidisciplinary approach. Each individual should be evaluated objectively and the treatment process of each individual has its own unique differences. The aim of this study is to discuss the effectiveness of staged feminizing genitoplasty operations using the total urogenital mobilization technique. Material and methods: Hospital records of patients who underwent vaginoplasty using the TUM technique between 2014 and 2019 by a single surgeon in a pediatric surgery center of a tertiary pediatric hospital were retrospectively reviewed. Results: All ten patients who underwent TUM had 46 XX chromosomes. The TUM procedure for vaginoplasty was performed in all patients by the author. A clitorolabioplasty had been previously performed in six patients with congenital adrenal hyperplasia. The follow-up period of the patients was 1-6 years. No serious complications developed in any of the patients. Neither infection nor tissue necrosis occurred. A second surgical procedure was not required for urinary fistula, vaginal stenosis, urinary incontinence, or early suture dehiscence. Conclusion: This study shows that vaginoplasty can be performed in a single session in infancy for patients with low confluence and a short Urogenital Sinus (UGS). Apart from this, postponing vaginoplasty surgeries to the adolescence period and performing UGS mobilization surgery seem to carry successful results.
{"title":"Staged feminizing genitoplasty with total urogenital sinus mobilization","authors":"Akbiyik Fatih","doi":"10.17352/2455-2968.000151","DOIUrl":"https://doi.org/10.17352/2455-2968.000151","url":null,"abstract":"Background: The diagnosis and treatment of individuals with Disorders of Sexual Development is a complex process and requires a multidisciplinary approach. Each individual should be evaluated objectively and the treatment process of each individual has its own unique differences. The aim of this study is to discuss the effectiveness of staged feminizing genitoplasty operations using the total urogenital mobilization technique. Material and methods: Hospital records of patients who underwent vaginoplasty using the TUM technique between 2014 and 2019 by a single surgeon in a pediatric surgery center of a tertiary pediatric hospital were retrospectively reviewed. Results: All ten patients who underwent TUM had 46 XX chromosomes. The TUM procedure for vaginoplasty was performed in all patients by the author. A clitorolabioplasty had been previously performed in six patients with congenital adrenal hyperplasia. The follow-up period of the patients was 1-6 years. No serious complications developed in any of the patients. Neither infection nor tissue necrosis occurred. A second surgical procedure was not required for urinary fistula, vaginal stenosis, urinary incontinence, or early suture dehiscence. Conclusion: This study shows that vaginoplasty can be performed in a single session in infancy for patients with low confluence and a short Urogenital Sinus (UGS). Apart from this, postponing vaginoplasty surgeries to the adolescence period and performing UGS mobilization surgery seem to carry successful results.","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44282719","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 : 2022-03-29DOI: 10.17352/2455-2968.000147
Al-Roubaie Aymen, Perry Jacques
Swallowed foreign bodies are uncommon during general anesthesia. In the majority of the cases, these foreign bodies are passed spontaneously and uneventfully and the minority requires endoscopic or surgical intervention. It is recommended that every removable prosthesis should be removed, labeled, and stored in a safe place preoperatively. Furthermore, if a foreign body was missing, proper notification should be done in the immediate postoperative period to enable early detection and avoid any complications that might result from its impaction in distal places. This paper reports a case of a swallowed denture during induction of anesthesia. The clinical and imaging findings are presented along with a review of the literature. A 53-year old woman was admitted for laparoscopic cholecystectomy. A week postoperatively, the patient reported a colicky lower abdominal pain increasing in severity. Lower quadrants deep tenderness was elicited by examination. A foreign body was detected within the proximal rectum by abdominal CT scan. The foreign body was the patient’s denture that was not removed earlier during the induction of anesthesia. Endoscopic foreign body removal was done by flexible sigmoidoscopy. This case report highlights the importance of removing any removable prosthesis before induction of anesthesia and reporting any missing prosthesis such as dentures in the immediate postoperative period.
{"title":"Denture in the rectum: A case report","authors":"Al-Roubaie Aymen, Perry Jacques","doi":"10.17352/2455-2968.000147","DOIUrl":"https://doi.org/10.17352/2455-2968.000147","url":null,"abstract":"Swallowed foreign bodies are uncommon during general anesthesia. In the majority of the cases, these foreign bodies are passed spontaneously and uneventfully and the minority requires endoscopic or surgical intervention. It is recommended that every removable prosthesis should be removed, labeled, and stored in a safe place preoperatively. Furthermore, if a foreign body was missing, proper notification should be done in the immediate postoperative period to enable early detection and avoid any complications that might result from its impaction in distal places. This paper reports a case of a swallowed denture during induction of anesthesia. The clinical and imaging findings are presented along with a review of the literature. A 53-year old woman was admitted for laparoscopic cholecystectomy. A week postoperatively, the patient reported a colicky lower abdominal pain increasing in severity. Lower quadrants deep tenderness was elicited by examination. A foreign body was detected within the proximal rectum by abdominal CT scan. The foreign body was the patient’s denture that was not removed earlier during the induction of anesthesia. Endoscopic foreign body removal was done by flexible sigmoidoscopy. This case report highlights the importance of removing any removable prosthesis before induction of anesthesia and reporting any missing prosthesis such as dentures in the immediate postoperative period.","PeriodicalId":93785,"journal":{"name":"Journal of surgery and surgical research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47766761","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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