Complications of Roux-en-Y gastric bypass.

INTRODUCTION: Bariatric surgery is a method of treating morbid obesity, which has been raising more and more interest in the past years. Among all types of intervention, the most frequently used is Roux-en-Y gastric bypass, an intervention both restrictive and malabsorptive, which leads to best results in weight loss. In Romania, bariatric surgery, and especially Roux-en-Y gastric bypass, is not widely practiced due to poor addressability of patients, both due to lack of information, and to poor recommendation from general practitioners and specialists in metabolic diseases. MATERIAL AND METHOD: The study group includes 14 patients aged between 18 and 65 years old, with BMI above 40 kg m2. The study aims to present the complications that occurred in this group of patients in which we performed Roux-en-Y gastric bypass in the Surgery Department of the Emergency City Hospital Timisoara. The surgery was performed by xifo-umbilical laparotomy technique. Subsequently, patients were followed postoperatively at 1 month, and then every 3 months, up to 2 years. RESULTS: The only complications we found were wound infections (7/14 - 50%) and incisional hernias (5/14 - 35.71%). CONCLUSIONS: We only found in our group only complications related to the postoperative wound that can be minimized by modifying the suturing technique of the abdominal wall. Gastric bypass should be performed despite all incriminated risks, providing a better lifestyle to obese patients.

Multifocal choroidal metastases from thyroid carcinoma: a case report.

We present the case of a 62-year-old female patient, with follicular variant of papillary thyroid carcinoma, which presented to our department for a severe decrease in vision at right eye level. Despite a complex therapy, that included a near-total thyroidectomy, thyroid I-131 ablation, suppressive therapy with LT4, and external beam radiotherapy with cobalt- 60, the patient developed multiple lung, mediastinal, liver, and bone metastases, followed after 1 year, by multifocal choroidal metastases. The complex ocular investigations performed for the diagnosis and follow-up of the choroidal metastases are presented. A review of the literature was also performed. The rarity of choroidal metastases in patients with thyroid carcinoma imposes, for their detection, periodic ocular examinations.

Postoperative morbidity and mortality after liver resection. Retrospective study on 133 patients.

INTRODUCTION: Hepatic resection had an impressive growth over time, both by broadening the range of its indications and the occurrence of changes and technical tricks in order to reduce postoperative mortality and morbidity. MATERIAL AND METHODS: This study is a retrospective study presenting an analysis of 133 patients hospitalized in the Department of Hepatic Surgery in City Hospital Timisoara, between January 2000 and November 2011, in which a surgical intervention was performed, either for a primary hepatic tumor (benign or malignant) or a secondary liver tumor. All cases were analyzed in terms of etiopathogenesis, preoperative and intraoperative investigations, indication and type of hepatectomy performed, the surgical technique used and postoperative evolution. RESULTS: The study group comprises 133 patients. From the whole group, 100 patients (75.19%) were diagnosed with primitive liver tumors, in 70 patients (70% of primary tumors) HCC occurring on a cirrhotic liver. Liver disease was secondary in 33 patients (24.81%), colorectal tumors being most commonly involved (19 patients). Of all liver resections, 21 (15.79%) were major hepatectomies. The remaining were minor hepatectomies, including a trisegmentectomy (V, VI, VII), 51 bisegmentectomies and 60 liver resections limited to one segment. Vascular clamping was used in 89 cases (66.92%), pedicular clamping in 65 patients (73.03%) and selective extraglissonian clamping in 24 patients (26.97%) respectively. Of the 33 patients with liver metastases, 12 (36.36%) received synchronous resections. The most common complication in our study group was postoperative liver failure, found in 45 patients (33.83%), being irreversible in one case (2.22%), followed by the death of the patient. In 34 patients (75.55%), hepatic failure was seen in cirrhotic patients and the other cases were patients with major hepatec-tomies. Hepatic failure occurred in 35 patients (77.78%) with vascular clamping, four of them after selective clamping. 31 of the patients (68.89%) with postoperative liver failure were transfused, 25 patients (55.55%) receiving more than 2 units of blood. Of all patients, 3 (2.25%) died postoperatively. CONCLUSIONS: Respecting the principles of liver surgery, hepatic resection can be performed, even in cirrhotic patients, with acceptable morbidity and minimal mortality. The most common complication after hepatic resection, in our study group, was postoperative liver failure, which was mostly reversible.

[Intestinal fistula--a complication in the surgical treatment of the substitution mesh infection]. / Fistula intestinala--complicatie în tratamentul chirurgical al infectiei plasei de substitutie.

The infection of the substitute mesh, used in the treatment of the large abdominal eventrations is a very severe complication for the patient and also for the surgeon. The surgical treatment of this complication represents the ablation of the mesh with concomitant evacuation of the purulent collection and the annihilation of the infectious source. In the next stage, it will be applied a reconstruction method of the abdominal wall. The ablation of the mesh, especially if the infection was continuous for a long period, is very difficult and can have as consequences severe complications, one of them being the small intestine fistula. This paper presents the case of one patient with an infection of the substitution mesh that had a continuous evolution over a long period, approximately 3 years, and its ablation being complicated with a small intestine fistula.

[The role of patellar lateral release and augmentation of median retinaculum of patellae in treatment of femoro-patellar malalignment]. / Rolul sectiunii retinaculului rotulian lateral si augmentarii retinaculului rotulian median în rezolvarea mal-alinierilor femuropatelare.

Patellar misalignment is more common than usually supposed; many patients learn to live with this affection without seeing a doctor. A large number of open surgical procedures were described for treatment of misalignment of extensor mechanism of knee. We want to present our method which consisted in arthroscopic lateral release and augmentation of medial retinaculum. We had 47 patients with femoro-patellar misalignment treated with this method. The results were appreciated by clinical and radiological criteria (patellar glide test, patellar tilt test, Macnab scores, Merchant angle). The follow-up was two years. Only 17% had recurrence of clinical signs.

[The limits of surgery in the treatment of the icteric patients due to pancreatic head cancer]. / Limitele tratamentului chirurgical al neoplasmului de cap de pancreas la pacientii icterici.

Aim is to present the limits of surgery, determined by the dimension of the tumor and vascular invasion, in the treatment of the icteric patients with pancreatic head cancer. This paper is a retrospective study realized in Timisoara City Hospital, Surgery Clinic, on 68 patients, hospitalized for icteric syndrome due to pancreatic head cancer. Surgery was performed in 66 patients: 4 (6%) pancreaticoduodenectomy, Whipple modified technique, 62 (94%) palliative surgery which consists in a biliodigestive shunt associated with a gastroenterostomy, and 2 patients were not operated. In palliative treatment, 10 (15%) patients had complications and 3 (4.5%) died within 1 month after surgery. In the case of the patients with duodenopancreatectomy, there was no morbidity or mortality. Survival after one year was 0% in palliative treatment and 100% in pancreaticoduodenectomy. In icteric patients due to pancreatic head cancer, the possibility of pancreaticoduodenectomy without vascular resection is reduced (6%). Modified Whipple technique was imposed by the dimensions of the tumor (more than 3 cm) and vascular invasion, determining in the first place, the dissection of the vascular tree: portal, mesenteric, caval; and pancreaticoduodenectomy was performed only if there was no invasion.

[Post-traumatic acute appendicitis in hernia's sac]. / Apendicita acuta postraumatica în sac herniar.

The paper presents two unusual pathological aspects of a hernia and an appendicitis. It is about a massive old inguinal hernia, with strangulation and an intra-saccular congestive acute appendicitis that occurred after a traumatic injury of the region. The presumptive diagnosis through a dynamic monitoring of the patient, clinical and biological analysis has made possible a favorable solution of the case.

[Bronchoscopy in thoracic trauma]. / Bronhoscopia în traumatologia toracica.

Thoracic trauma often bears difficult problems of diagnosis and treatment. This paper reports 87 procedures on 20 severe thoracic injured patients, who have also suffered multiple injuries, to whom was performed bronchoscopy. These cases were regarding gender, age, traumatic cause, associated injuries and dynamic endo-bronchial aspect. There are detailed technique used in bronchoscopy and bronchoscopic suction, additional diagnostic procedures, technical tips, incidents and are also reported close and follow up results in these cases. We discuss indications of bronchoscopy and broncho-aspiration in thoracic trauma from diagnostic and treatment point of view. Conclusions underline major role of bronchoscopy in the management of severe thoracic trauma.

[Synchronous sigmoid and superior rectal resection and left hepatic lobectomy extended to Spiegel lobe for a sigmoid cancer with hepatic metastasis. Case report]. / Rezectie sincrona, de colon sigmoid si lobectomie hepatica stângâ extinsa la segmentul I pentru un neoplasm sigmoidian cu metastaze hepatice.

The recent developments of surgical technologies allowed the achievement of some standardized interventions with anatomical and functional visa, which based on the improvement of anesthesia and intensive care, and not least by elaboration of efficient chemotherapy protocols, determined new horizons in the treatment of advanced cancers. This work presents a case witch was hospitalized at the Department of Hepatic Surgery, of City Hospital from Timisoara for a colorectal cancer stage IV (T3N1M1), with hepatic metastasis localized at the left hepatic lobe (II and III segments) and Spiegel lobe. A surgical intervention was performed, when in the same operating time was practiced a sigmoid and superior rectal resection (Hartmann) and also a left hepatic lobotomy extended to the first segment. The post operating evolution of the patient was favorable and also after fourth month from the surgery, when no signs of relapse were established at reevaluation.

[A retrospective study of 83 patients hospitalized for a jaundice syndrome in the Surgical Clinic of Timisoara Municipal Hospital]. / Studiu retrospectiv privind 83 de pacienti internati pentru un sindrom icteric în clinica de chirurgie a Spitalului municipal Timisoara.

This is a retrospective study done on 83 patients admitted to surgical department of Timisoara Emergency Hospital in the period between 01/01/1992 and 31/03/1995; 47 patients were males, 36 females with mean age 56.1 years. All patients suffered from jaundice mainly conjugated hyperbilirubinemia. The causes of jaundice were: malignant tumours in 19 (22.9%), chronic diffuse parenchymatous liver disease in 24, stone common bile duct 22, benign biliary strictures and papillary stenosis in 6, extrinsic biliary compression and inflammation in 12. Surgery was done in 47 patients and medical treatment in 36 patients. During hospitalization, complications occurred in 19 patients. The condition of patients at discharge was considered: cured in 30, improved in 38, stationary in 2 and deteriorated in 12. Mortality occurred in one patient.

[The rejection of a hepatic graft]. / Rejetul de grefa hepatica.

Hepatic graft rejection is an epiphenomenon of liver transplantation. Despite the immunosuppressive therapy, nowadays a level of 30-50% of acute rejection and 5-15% chronic rejection is always persisting. Graft rejection prophylaxis essentially represents the result of a subtle equilibrium of the chronic immunosuppression. This study presents the essential data concerning the graft rejection, such as: prevalences, classifications, clinical presentation and diagnostic, both anatomopathological and differential. Modern therapy of hepatic graft rejection is also presented.

[Liver transplantation. I. Its history. The indications. Clinical efficacy]. / Transplantul hepatic. I. Istoric. Indicatii. Eficienta clinica.

The aim of this study is to present the actual indications of the liver transplantation in adult as well as in children patients. A multicenter comparative study based on the already published reports in Europe and in the United States has been done in order to analyse the survival rates for different liver diseases subjected to liver transplantation, as well as the prevalence of these nosologic entities in different hepato-biliary centers. Such an analysis is badly needed in Romania, where the prevalence of liver diseases is relatively high, and in the context of the initiation of transplantation in our country.