The Impact of Cancer Stem Cells in Colorectal Cancer.

Despite incessant research, colorectal cancer (CRC) is still one of the most common causes of fatality in both men and women worldwide. Over time, advancements in medical treatments have notably enhanced the survival rates of patients with colorectal cancer. Managing metastatic CRC involves a complex tradeoff between the potential benefits and adverse effects of treatment, considering factors like disease progression, treatment toxicity, drug resistance, and the overall impact on the patient's quality of life. An increasing body of evidence highlights the significance of the cancer stem cell (CSC) concept, proposing that CSCs occupy a central role in triggering cancer. CSCs have been a focal point of extensive research in a variety of cancer types, including CRC. Colorectal cancer stem cells (CCSCs) play a crucial role in tumor initiation, metastasis, and therapy resistance, making them potential treatment targets. Various methods exist for isolating CCSCs, and understanding the mechanisms of drug resistance associated with them is crucial. This paper offers an overview of the current body of research pertaining to the comprehension of CSCs in colorectal cancer.

Cholecystectomy in Mild and Moderate Acute Pancreatitis: A Retrospective Study.

Background: Cholecystectomy has been a subject of debate regarding its timing and utility in cases of mild and moderately severe acute pancreatitis (AP). We aimed to critically evaluate the role of early cholecystectomy in the management of mild and moderate AP, considering patient's characteristics, associated procedures, and overall impact on patient outcomes. Methods: The study compared the outcomes between patients admitted in a tertiary care surgical center undergoing early ( 96h) versus delayed ( 96h) laparoscopic cholecystectomy (LC) for mild and moderately severe acute gallstone pancreatitis between January 2019 and December 2022. Results: The study included 54 cases [mean (standard deviation) age, 59.4 (16.5) years; 31 (57.4%) years females]. All patients underwent LC, with 29 cases undergoing a two-phase therapeutic regimen for common bile duct (CBD) lithiasis, consisting of endoscopic retrograde cholangiopancreatography followed by sequential LC. The early cholecystectomy group (EC) comprised 17 patients (31.5%), while the delayed cholecystectomy group (DC) included 37 patients (68.5%). EC was significantly correlated with lower length of stay (p-value 0.0001) and significantly lower rate of ERCP usage during perioperative period. Conclusions: EC in the first 4 days after admission provides significant benefits such as prevention of recurrent pancreatitis, reduction in complications, and decreased length of stay for patients with mild and moderately severe AP.

Impact Of Comorbidities On Outcomes And Healthcare Costs Of Open Inguinal Hernia Repair In Patients With Diabetes Mellitus.

INTRODUCTION: Inguinal hernia management in patients with diabetes mellitus (DM) and comorbidities presents challenges due to potential impacts on wound healing and infection risk. This study evaluates the influence of additional comorbidities on outcomes following open inguinal hernia repair in DM patients. MATERIAL AND METHODS: A retrospective cohort study was conducted at Craiova Emergency Clinical County Hospital from 2015 to 2020. Patients with documented DM undergoing hernia repair were categorized into two groups based on comorbidity status. Data on presentation mode, hernia type, comorbidities, hospitalization, operative details, postoperative outcomes, and costs were collected and analyzed statistically. RESULTS: Among 38 DM patients undergoing hernia repair, 16 were in Group A (DM alone) and 22 in Group B (DM with comorbidities). Group B patients were older (p = 0.0002) and more likely to present emergently (OR: 13.81, p=0.0148) with incarcerated (OR: 22.733, p=0.0339) or strangulated hernias (OR: 9.4545, p=0.0390). Group B had longer hospitalizations (p=0.00132) and higher hospitalization costs (p = 0.00262). CONCLUSIONS: DM patients with comorbidities are at higher risk for complex hernias and prolonged hospitalizations. Pulmonary fibrosis emerges as a significant comorbidity requiring specific perioperative strategies. Tailored preoperative assessments and care plans can optimize outcomes.

Parathyroid Cancer-A Rare Finding during Parathyroidectomy in High Volume Surgery Centre.

Background and Objectives: Parathyroid cancer is a very rare endocrine tumor, especially in patients with secondary hyperparathyroidism due to end stage renal disease failure. This pathology is difficult to diagnose preoperatively because it has nonspecific clinical manifestations and paraclinical aspects. Our study of the literature identified 34 reported cases of parathyroid carcinoma over the last 40 years in patients undergoing dialysis. We present our experience as illustrative of the features of clinical presentation and histopathological findings of parathyroid carcinoma and assess its management considering the recent relevant literature. Materials and Methods: From January 2012 to November 2022, 650 patients with secondary hyperparathyroidism undergoing dialysis were treated at our academic Department of General Surgery and only two cases of parathyroid carcinoma were diagnosed on histopathological examination. Results: All patients presented with symptomatic hypercalcemia, with no clinical or imaging suspicion of malignant disease and were surgically treated by total parathyroidectomy. Histopathological examination revealed morphologic aspects of parathyroid carcinoma in two cases and immunostaining of Ki-67 was performed for diagnostic confirmation. Postoperative follow-up showed no signs of recurrence and no oncological adjuvant treatment or surgical reinterventions were needed. Conclusions: Parathyroid neoplasia is a particularly rare disease, that remains a challenge when it comes to diagnosis and proper management. Surgical approach is the only valid treatment to remove the malignant tissue and thus improve the patient's prognosis. Medical and oncologic treatment may be beneficial to control hypercalcemia in case of tumor recurrence.

CD34-Structure, Functions and Relationship with Cancer Stem Cells.

The CD34 protein was identified almost four decades ago as a biomarker for hematopoietic stem cell progenitors. CD34 expression of these stem cells has been exploited for therapeutic purposes in various hematological disorders. In the last few decades, studies have revealed the presence of CD34 expression on other types of cells with non-hematopoietic origins, such as interstitial cells, endothelial cells, fibrocytes, and muscle satellite cells. Furthermore, CD34 expression may also be found on a variety of cancer stem cells. Nowadays, the molecular functions of this protein have been involved in a variety of cellular functions, such as enhancing proliferation and blocking cell differentiation, enhanced lymphocyte adhesion, and cell morphogenesis. Although a complete understanding of this transmembrane protein, including its developmental origins, its stem cell connections, and other functions, is yet to be achieved. In this paper, we aimed to carry out a systematic analysis of the structure, functions, and relationship with cancer stem cells of CD34 based on the literature overview.

Clinical and Morphological Characteristics of Gastrointestinal Stromal Tumor.

Introduction: Gastrointestinal stromal tumors (GIST) are a rare form of cancer located within the gastrointestinal (GI) tract, defined as tumors with spindle, epithelioid, or occasionally pleomorphic cells. They originate in the interstitial cells of Cajal, with the function of "pacemaker" of gastrointestinal motility. Their behavior is dictated by changes in the c-kit/PDGFRA gene, which is often highlighted by immunolabeling. Methods: We report the clinical, macroscopic, microscopic, and immunohistochemical characteristics of consecutive patients diagnosed with GIST who underwent surgical removal of the tumor in our department between 2008-2022. Results: We included 20 consecutive patients. The presentation was considered a surgical emergency requiring immediate surgical intervention in most subjects. The most common localization is the small intestine (n=9, 45%), followed by the stomach (n=7, 35%), colon (n=3, 15%), and peritoneum (n=1, n=5%). Histologically, the tumors were predominantly mixed (n=10, 50%) followed by spindle type (n=8, 40%) and epithelioid - 2 cases (10%). Conclusion: The clinical presentation of GISTs remains heterogeneous, and the diagnosis is predominantly postsurgical, using complex immunohistochemistry analysis. The tumor size and number of mitoses are strongly associated with the long-term prognosis.

Comparison of Different Laparoscopic Sacrocolpopexy Procedures: A Retrospective Dual Center Analysis.

Introduction: Pelvic organ prolapse (POP) affects up to 50% of women and has a significant impact on quality of life. Abdominal sacrocolpopexy is the gold standard treatment for vault prolapse and laparoscopic sacrocolpopexy has many advantages. This study aimed to compare the results of two laparoscopic sacrocolpopexy procedures performed at two different surgical centers. Materials and Methods: The primary objective of this retrospective study was to assess surgical feasibility and complication rates associated with sacrocolpopexy procedures performed at Center A (using self-fixating mesh) and Center B (using sutured mesh). Secondary objectives included assessment of length of hospital stay, readmission rates, and surgical outcomes. The study included patients treated between January 2019 and October 2023. Results: Thirteen patients, six from Center A and seven from Center B, were included. Patient characteristics, such as age and body mass index, were similar between the two groups. Operative time and length of stay were not significantly different. Center A reported one postoperative complication (mesh erosion), which occurred two years after surgery and required laparoscopic intervention. Center B also reported one conversion to laparotomy because of metabolic acidosis and hypercapnia. Conclusion: The two laparoscopic sacrocolpopexy techniques were safe and effective for treating POP and our study confirmed the importance of mesh and fixation choices. Further research is needed to improve understanding of these surgical techniques.

The Role of Ileostomy in the Prevention and Treatment of Anastomotic Leakage after Elective Rectal Cancer Surgery - A Retrospective Analysis of Specific Risk Factors, Outcomes, and Complications.

Background: The objective of this paper is to highlight the role and place of ileostomy from the perspective of the risk of anastomotic leakage (AL). Materials and method: This was a retrospective study of 74 (46.54%) low and ultra-low anterior resections from 159 cases of rectal cancer operated on in a seven-year interval (2015 - 2021). The cases were divided into two groups: Group A with protective ileostomy (47 cases = 63.51%) and Group B without protective ileostomy (27 cases = 35.49%). Results: The type of anastomosis was low colorectal for 15 cases and ileorectal for two cases, both in Group A, with either mechanical or manual sutures. Continuous loop ileostomy was the only fecal diversion procedure used for protection. The ileostomy-specific complications recorded in Group A were peristomal skin lesions (8 cases), early peristomal hernia (2 cases), and severe dehydration with acute renal-insufficency (7 cases). The closure of the ileostomy was performed in 42 cases (89.36%), with the time between the primary operation and the closure being 4.28 months on average, with limits between 12 days and 10 months. AL treatment was conservative in 13 (76.47%) cases and surgical in four cases, with the types of operations performed at reintervention being take-down of the anastomosis + left terminal colostomy + ileostomy closure in three cases (2 in Group A and 1 in Group B) and terminal ileostomy in one case in Group A. Conclusions: To reduce its specific complications, ileostomy should be performed in well-selected patients. Those with risk factors for leakage include males, the elderly, and those having important comorbidities, neoadjuvant chemoradiotherapy, low tumors below 5 cm from the anal verge, or complete circumferential stenosis and peritumoral inflammatory infiltrate.

Management of Anastomotic Leakage after Low Anterior Rectal Resections with Total Mesorectal Excision - A Retrospective Study.

Background: This study sought to investigate the diagnostic procedures, treatment modalities, and consequences of anastomotic leakage (AL) in low anterior resection rectal cancer patients. Methods: A retrospective analysis was conducted on 186 patients consecutively admitted and treated in the 1st Department of Surgery in Craiova, between January 2018 and June 2022, all of whom had undergone surgical interventions for adenocarcinoma of the rectum. Among this cohort, 106 patients who had undergone scheduled low and ultralow anterior rectal resections with total mesorectal excision were selected for further analysis. Twenty-four patients were diagnosed with postoperative AL and underwent diverse management strategies based on the severity of their condition. Results: The study revealed an incidence of 22.6% for postoperative AL, with all of them being classified as grade B and C, according to the 2010 International Study Group of Rectal Cancer Classification, which were associated with significant morbidity and mortality. Notably, patients exhibited various comorbidities, including obesity, arterial hypertension, type 2 diabetes mellitus, and kidney failure. The management approach depended on the severity of the clinical presentation and the availability of treatment options. Early diagnosis and conservative management constituted the initial therapeutic strategy for grade B AL, with surgical reintervention or transanal vacuum therapy being used in grade C AL. Conclusions: The incidence and mortality associated with AF following low anterior resections were notably elevated. Grade B AL were successfully managed through conservative treatment, whereas grade C AL required either surgical reintervention for drainage or diversion procedures, or transanal vacuum therapy.

Open and Laparoscopic Surgical Approache in Incisional Hernias: A Descriptive Analysis.

Background: Incisional hernias, occurring in 10-20% of patients post-abdominal surgery, significantly affect patient quality of life and healthcare systems. This study analyses two hernia repair methods: laparoscopic intraperitoneal onlay mesh (IPOM) and open on-lay hernioplasty. Key analysis factors include operative time, postoperative pain, complications, length of hospital stay, recovery speed, and recurrence rates, with the goal of identifying the most effective and beneficial approach for patients. Methods: We conducted a retrospective study on 70 patients with postoperative parietal defects at the Dr Carol Davila Clinical Nephrology Hospital, Bucharest, from January 2018 to December 2021. Patients underwent either laparoscopic IPOM (42 patients) or open hernioplasty (28 patients) for uncomplicated incisional hernia repair. We analyzed demographic data, comorbidities, defect size and location, previous surgeries, and surgical outcomes. Results: The laparoscopic group had a slightly shorter operative time and significantly lower postoperative pain levels, as assessed by the Visual Analog Scale. The laparoscopic approach also resulted in shorter hospital stays and quicker return to routine activities. Complications, such as seroma and hematoma, were more common in the open surgery group, but no wound infections or prosthesis rejections were observed in either group. Notably, the open surgery group showed a higher recurrence rate (11 %) compared to none in the laparoscopic group within a one-year follow-up. Conclusion: Laparoscopic IPOM for incisional hernia repair shows benefits over open hernioplasty, with less pain, shorter hospitalization, faster recovery, and lower recurrence. Its growing preference and potential for further research are highlighted.

Therapeutic Options in Postoperative Enterocutaneous Fistula-A Retrospective Case Series.

OBJECTIVES: The aim of the study was to present the results obtained in our experiment regarding the management of postoperative enterocutaneous fistulas (PECF). MATERIALS AND METHODS: We conducted a retrospective study on 64 PECF registered after 2030 abdominal surgeries (1525 digestive tract surgeries and 505 extra-digestive ones) over a period of 7 years (1st of January 2014-31th of December 2020) in the 1st and 2nd Surgery Clinics, Clinical County Emergency Hospital of Craiova, Romania. The group included 41 men (64.06%) and 23 women (35.34%), aged between 21-94 years. Of the cases, 71.85% occurred in elderly patients over 65 years old. Spontaneous fistulas in Crohn's disease, intestinal diverticulosis, or specific inflammatory bowel disease were excluded. RESULTS: The overall incidence of 3.15% varied according to the surgery type: 6.22% after gastroduodenal surgery, 1.78% after enterectomies, 4.30% after colorectal surgery, 4.28% after bilio-digestive anastomoses, and 0.39% after extra-digestive surgery. We recorded a 70.31% fistula closure rate, 78.94% after exclusive conservative treatment and 57.61% after surgery; morbidity was 79.68%, mortality was 29.68%. CONCLUSION: PECF management requires a multidisciplinary approach and is carried out according to an algorithm underlying well-established objectives and priorities. Conservative treatment including resuscitation, sepsis control, output control, skin protection, and nutritional support is the first line treatment; surgery is reserved for complications or permanent repair of fistulas that do not close under conservative treatment. The therapeutic strategy is adapted to topography, morphological characteristics and fistula output, age, general condition, and response to therapy.

Interstitial Cells of Cajal-Origin, Distribution and Relationship with Gastrointestinal Tumors.

The interstitial cells of Cajal (ICC) represent a particular network formed by some peculiar cells that were first described by the great neuroanatomist, S. Ramon y Cajal. Nowadays, the ICC have become a fascinating topic for scientists, arousing their curiosity; as a result, there is a vast number of published articles related to the ICC. Today, everybody widely accepts that the ICC represent the pacemaker of the gastrointestinal tract and are highly probable to be the origin cells for gastrointestinal tumors (GISTs). Recently, Cajal-like cells (ICLC) were described, which are found in different organs but with an as yet unknown physiological role that needs further study. New information regarding intestinal development indicates that the ICC (fibroblast-like and muscle-like) and intestinal muscle cells have the same common embryonic cells, thereby presenting the same cellular ultrastructure. Nowadays, there is a vast quantity of information that proves the connection of the ICC and GISTs. Both of them are known to present c-kit expression and the same ultrastructural cell features, which includes minimal myoid differentiation that is noticed in GISTs, therefore, supporting the hypothesis that GISTs are ICC-related tumors. In this review, we have tried to highlight the origin and distribution of Cajal interstitial cells based on their ultrastructural features as well as their relationship with gastrointestinal stromal tumors.

Emergency and Trauma Surgery.

According to the UEMS (Union Europeene des Medicins Specialises) Section of surgery Board of Surgery, "Emergency Surgery" can be defined "as surgery that is required to deal with an acute threat to life, organ, limb or tissue caused by external trauma, acute disease process, acute exacerbation of a chronic disease process, or complication of a surgical or other interventional procedure". Performance of emergency surgery require complex and varied skills and abilities to achieve procedures from different fields of surgery: abdominal, urologic, thoracic, vascular, soft tissue, skeletal) within an interval of 24 hours (1). In U.S., since 2008, Acute Care Surgery concept was introduced, and nowadays is an evolving specialty with three essential components- trauma, critical care and emergency surgery (2). In UK there is an increasing subspecialisation within general surgery over the last ten years. More recently, there has been an increase in focus on emergency general surgery (3,4). This may not come as a surprise given the fact that trafic crashes kill 1.2 million people annually around the world (3242 people/day) and 90% are in middle and low income countries. In US trauma is the leading cause of death in persons up to 40 years. Optimal care for emergency surgical patients is one of the major challenges for every healthcare system worldwide. An emergency surgery mai intervene during the daily schedule of elective interventions and create pressure on both the organisation and costs (5). Since it's birth, in 2007, the Romanian Society for Emergency Surgery and Trauma was involved in supporting the development of practice in emergency surgery in Romania by many actions: each year, during biannual National Congres and National Conference of the Romanian Society of Surgery 2 sessions were dedicated to emergency surgery, with invited foreign speakers; oragnisation of European Congres of Emergency and Trauma Surgery in 2017 in Bucharest, 1 tematic issue of Chirurgia Journal dedicated to surgery of the cirrhotic patients. This tematic isssue includes varia subjects from emergency surgery in valuable articles. The management of open abdomen management are depicted by Anastasiu et al, in a review summarizing definition, classification, indications, methods of temporary abdominal closure and fascial closure, and enterocutanous fistula. Turculet et al, perfomed a review of the litterature to describe the main advantages and disadvantages of the trauma systems in Europe and to present the last concepts regarding the management of the polytrauma patients and the newest sets of measures to prevent car crashes in European Union. A rare case of small bowel hemangioma with hemoperitoneum mimicking trauma is described by Iordache et al, with a review of the litterature. The series of reviews ends with an interesting article for daily practice in emergency hospitals about the diagnostic and therapeutic peculiarities in abdominal trauma associated with spinal cord injurie by Grigorean et al. Abdominal trauma is addressed in 7 original papers. The definitive surgery for liver trauma in tertiary HPB center, the nonoperative treatment of abdominal trauma involving liver and spleen, the timing of splenic interventional radiology, the management of colon trauma at a level II trauma, challenges raised by the retroperitoneal hematoma in abdominal trauma, predicition of evolution of patients with abdominal trauma using the usual biological parameters, and clinico-pathological correlations in the acute surgical abdomen in the pre and post COVID-19 pandemic period are presented, analysed and discussed in papers coming from specialized surgical units from Fundeni Clinical Institute, Emergency Clinical Hospital Bucharest, Emergency University Hospital of Bucharest, "Bagdasar-Arseni" Clinical Emergency Hospital, "St. Pantelimon" Clinical Emergency Hospital, Clinical County Emergency Hospitals of Craiova and Tg-Mures. The surgical technique of intraomental splenic implant and an attempt of reassessement is presented in a paper by Beuran et al. We hope that this tematic issue will be an interesting and very useful lecture for our readers and bring useful informations for those involved in emergency surgery.

The Management of the Open Abdomen - A Literature Review.

An essential component of the concept of "Damage control surgery", laparostomy is the procedure by which the abdomen is deliberately abandoned open, the visceroperitoneal contents being temporarily protected by multiple technical means. Actual classification: Grade 1, without viscero-parietal adhesions or fixity of the abdominal wall (lateralization), divided into: 1A clean, 1B contaminated and 1C enteral fistula -cutaneous skin is considered clean); Grade 2, which develops fixation is subdivided into: 2A clean, 2B contaminated and 2C enteral fistula; Grade 3, "frozen abdomen", is divided into: 3A clean and 3B contaminated; Grade 4, defined as enteroatmospheric fistula, is a permanent fistula associated with the presence of granulation tissue and a frozen abdomen. Indications of the open abdomen are: damage control surgery, abdominal compartment syndrome, peritonitis, severe acute pancreatitis, vascular emergencies. Temporary abdominal closure may be achieved by following methods: skin only closure, â??Bogota bagâ?Â, opsite Sandwich technique, absorbable mesh, non-absorbable mesh or commercial zipper, vaccum asisted closure, each with its own advantages and disadvantages. Regarding the definitive closure this can be achieved by non mesh and mesh mediated techniques. Component separation technique anterior and posterior should be considered the elective repair procedure in parietal defects after laparostomy. Although several studies have been published, there is still no consensus in the literature on the positioning of prosthetic material in relation to parietal planes. Some authors suggest better results (relative to the rate of recurrence and complications) for implantation in the "sublay" position. Open abdomen is an important tool in the arsenal of the emergency surgery. Classification, indications, methods of temporary abdominal closure are evolving, as well as management of enterocutaneous fistulas and fascial closure, therefore permanent update is neccessary to offer patients the best care.

Nonoperative Treatment of Abdominal Trauma Involving Liver and Spleen.

Introduction: The management of this type of trauma has evolved considerably, especially with the introduction of interventional radiology (angiography, splenic artery embolization - SAE) but also the concept of non-operative treatment (NOT), defined as a follow-up of injuries, without surgery. Material and Method: We have established a strategy for dealing with cases of abdominal trauma with injuries by non-operative treatment (NOT). We applied NOT to 13 patients in 50 (26%), of which 8 were patients with spleen injuries and 5 were patients with liver damage. Most of the lesions were grade II (8 cases), 2 cases were grade I and 3 cases were grade III. Results: There was only one case dealt by NOT, in which surgery was performed 48 hours after admission. In two patients with extravasation of the contrast agent on CT and angiography, angioembolization of the splenic artery was performed, with good results. Control CT was performed at a period that varied between 24 hours and 5 days after admission. The average period of hospitalization of patients approached by NOT was 6,6 days. Conclusions: Contrast-enhanced CT examination remains the basis for NOT initiation, providing the necessary data on the degree of liver or splenic lesion, the size of blood collections and extravasation of the contrast substance but is also the essential imaging exploration in assessing NOT efficacy. Angioembolization can be successfully performed in cases where CT examination and angiography show contrast extravasation. There was only one case included in the NOT, which was operated laparoscopically, but most authors emphasize that this should not be considered a failure of the method.

Which is the Optimal Method of Reconstruction After Laparoscopic Right Hemicolectomy, the Intracorporeal or Extracorporeal Anastomosis Technique?

Introduction: The laparoscopic approach to right colectomy is gradually gaining a leading role in the surgical treatment of right colonic diseases. However, not all aspects of the procedure are standardized and the method of reconstruction of the digestive tract is still under debate. The present study critically evaluates the extracorporeal (EA) and intracorporeal (IA) techniques used for creation of the ileocolic anastomosis during a laparoscopic right colectomy. Material and Method: The EA and IA anastomotic techniques are described in detail. The peri operative data of a cohort of consecutive patients operated by our surgical team was retrospectively recorded and analyzed regarding type of anastomosis, the path for transition from EA to IA and the incidence of postoperative complications. Furthermore, an analysis of randomized clinical trials, reviews and meta-analyses that provided a comparative evaluation of EA versus IA was performed to provide a more in-depth integration of our own data into the literature. Results: EA was used at the beginning of our experience but was later replaced by IA which became the favorite anastomotic technique. There was no anastomotic fistula recorded in the EA or IA groups but in our cohort IA was unexpectedly associated with higher incidence of peritoneal drainage, prolonged ileus, surgical site infections, anastomotic bleeding and chyloperitoneum. However, IA allows better visualization of the ileal and colonic stumps, avoids twisting of the anastomosis, prevents extraction-related tearing of the mesocolon and reduces the risk of post operative hernia. Data from the literature also shows that IA is generally associated with earlier postoperative return of bowel function, less morbidity and less postoperative pain. Conclusions: Based on this study and the data currently present in the literature it can not be concluded that IA should be considered as the standard of care for laparoscopic right colectomy. The decision for an EA or IA anastomosis ultimately belongs to the surgeon and is influenced by his surgical skill and experience. The results of ongoing randomized controlled trials on large group of patients may bring more clarity on this issue in the future.

Colorectal Surgery in Romania during the COVID-19 Pandemic.

As the COVID-19 pandemic extends, its negative consequences on the effectiveness of therapeutic programs - previously assumed by the medical community and imperatively suspended for a difficult-to-predict period of time - are becoming increasingly worrying. In this context, as the evidence-based recommendations are not possible, most of the national and international scientific societies tried to develop balanced recommendations (1-4). The Romanian Society of Coloproctology (SRCP) and the Romanian Association for Endoscopic Surgery (ARCE) have created a working group that, taking into account recent publications, the statements of international academic societies, the national legislative context and the unique experience of countries severely affected by this pandemic (China, Italy, Spain, USA, etc.) proposes for Romania, the following recommendations for medical practice in colorectal surgery during the COVID-19 pandemic. These recommendations are subjected to continuous review, depending on the global and national situation of the pandemic, the particular needs of each hospital, the recommendations of the competent authorities and the evolution of the literature that publishes the conclusions of ongoing clinical trials.

SRED-ARCE Recommendations for Minimally Invasive Interventions During the COVID-19 Pandemic in Romania.

The Romanian Society of Digestive Endoscopy (SRED) and the Romanian Association of Endoscopic Surgery (ARCE) have decided to establish a joint working group to elaborate specific recommendations for organizing the diagnostic and the minimally invasive interventional procedures, in the context of the COVID-19 pandemic. The recommendations are based on the guidelines of the international societies of endoscopy and gastroenterology (ESGE / BSG / ASGE / ACG / AGA), respectively endoscopic surgery (EAES SAGES) (4-8), on the experience of countries severely affected by the pandemic (Italy, France, Spain, USA, Germany, etc.) and they will be applied within the limits of measures imposed at local and governmental level by the competent authorities. On the other hand, these recommendations should have a dynamic evolution, depending on the upward or downward trend of the COVID-19 pandemic at regional and local level, but also according to the findings of professional and academic societies, requiring regular reviews based on the publica tion of further recommendations or international clinical trials. The objectives of the SRED and ARCE recommendations target the endoscopic and laparoscopic surgery activities, to support their non discriminatory used for diagnostic or therapeutic purposes, pursuing the demonstrated benefits of these procedures, in safe conditions for patients and medical staff.

Feasibility of a Portable Abdominal Insufflation Device for Controlling Intraperitoneal Bleeding After Abdominal Blunt Trauma.

Uncontrolled bleeding contributes to 30% to 40% of trauma-related deaths and is the leading cause of potentially preventable deaths. Currently, there is no effective method available to first responders for temporary control of noncompressible intraabdominal bleeding while patients are transported to the hospital. Our previous studies demonstrated that abdominal insufflation provides effective temporary bleeding control. The study aims to prove the feasibility (insufflation to a target pressure) and safety (cardiovascular and respiratory effects) of a novel portable abdominal insufflation device (PAID) designed to control the intraperitoneal bleeding caused by abdominal trauma. The PAID prototype is based on a patented design and manufactured via additive manufacturing. PAID contains a 16-g CO2 cartridge and an electronic pressure transducer. PAID was tested on a bench top and a swine animal model. For the animal model study, the intraperitoneal pressure as well as cardiorespiratory parameters (hearth rate, SpO2 [peripheral capillary oxygen saturation], and blood pressure) were continuously monitored during the insufflation procedure. The prototype functioned according to specifications on both bench top and animal models. CO2 insufflation of the peritoneal cavity was delivered up the target 20 mm Hg and maintained for 30 minutes from 1 or 2 cartridges in the swine model. No intraoperative incidents were registered, and all the recorded physiological parameters were within normal limits. The PAID prototype is a feasible, easy to use device that provides quick, controlled, and safe insufflation of the peritoneal cavity. Future studies will focus on testing the next-generation, semiautomatic PAID prototype in a severe intraabdominal injury model.

Intraoperative cardiovascular response of natural orifice transluminal endoscopic surgery versus laparoscopy: A comparative animal study.

BACKGROUND: Natural orifice transluminal endoscopic surgery (NOTES) emerged as a new alternative method in minimally invasive techniques. Although a very small number of studies have compared the physiologic response in NOTES to laparoscopy, the results remain controversial. AIM: This experimental animal study aims to evaluate the intraoperative cardiovascular and respiratory effects of pure transluminal natural orifice surgery and conventional laparoscopy. MATERIALS AND METHODS: Twenty female pigs (Sus scrofa domesticus) equally divided into two study groups were assigned to either pure natural orifice transluminal endoscopic techniques (Group 1) or conventional laparoscopic surgery (Group 2) and monitored intraoperatively in terms of heart rate (HR), systolic blood pressure (SBP) and O2saturation (SpO2) for 1 h. Both groups underwent simple surgical procedures such as gastrojejunostomy, oophorectomy and adnexectomy. RESULTS: All procedures were successfully completed. The findings indicated statistically significant differences between SBP (P = 0.0065) and SpO2(P = 0.027) in the two groups at the beginning of the interventions. HR showed significant differences during the last 20 min of the interventions (min 40 and 45; P < 0.001). For the whole procedure (from the beginning of the intervention to 60 min interval), HR, SBP and SpO2values showed no statistical difference. CONCLUSIONS: Although significant differences in terms of HR, mean blood pressure and SpO2were noted at specific intervals during surgery, no real variance of the cardiovascular parameters was observed when considering the entire procedure. Therefore, NOTES seems to be a safe approach with minimally intraoperative cardiovascular and respiratory implications.