Surgical treatment of a cystic neoplasm of the posterior mediastinum: Case report and literature review.

INTRODUCTION AND IMPORTANCE: The study presents a clinical case of removal of a paravertebral tumour by thoracoscopic method and a review of the literature on the diagnosis and treatment of posterior mediastinal tumours. CASE PRESENTATION: A 26-year-old female patient presented with an extradural, paravertebral posterior mediastinal tumour and complaints of low back pain. The mass was diagnosed by computer tomography (CT) and magnetic resonance imaging (MRI). The mass was mobilised from the adjacent vital structures without rupturing the capsule by thoracoscopic approach. The histological examination of the extracted mass was diagnosed as a bronchogenic cyst. CLINICAL DISCUSSION: Thoracoscopic surgery provides sufficient volume in the mediastinum to perform instrument manipulations with minimal damage to adjacent structures and meets oncological criteria. CONCLUSION: Thoracoscopic surgery of posterior mediastinal tumours demonstrates clinically significant benefits and treatment efficacy compared to open surgery, and is characterised by a low incidence of postoperative complications, short surgery duration, rapid postoperative recovery and better cosmetic effect.

Duodenum-preserving pancreatic head resection or pancreatoduodenectomy for the surgical treatment of paraduodenal pancreatitis: a retrospective cohort study.

PURPOSE: Paraduodenal pancreatitis (PDP) is an uncommon yet well-described type of focal chronic pancreatitis. The aim of our study was to compare the outcomes of surgical treatment of patients with PDP using pancreatoduodenectomy and duodenum-preserving pancreatic head resection (DPPHR). METHODS: A retrospective analysis of 153 consecutive patients with PDP was performed. Patients who were treated with either DPPHR or PD were enrolled. The primary endpoint of the study was pain control achieved at the time of follow-up. The secondary endpoints of the study were complication rate (Clavien-Dindo > 2), hospital length of stay, and 90-day mortality. All patients were followed up after discharge for the assessment of pain cessation for a minimal period of 10 months. RESULTS: The final study population consisted of 71 patients. A total of 14 patients (19.7%) underwent pancreatoduodenectomy, and 57 (80.3%) were managed with DPPHR. Complication rate was significantly lower in DPPHR group at χ2 = 4.2677, p < 0.05. Mean hospital length of stay was 9.3 days (range 3-29) in DPPHR group and 13.9 days (range 7-35) in PD group (p < 0.05). No postoperative mortality was recorded. The mean follow-up period of the patients after surgery was 41.8 ± 20.6 months (range 10-88). Pain scores at the time of operation were calculated as 50.9 ± 12.1 in DPPHR group and 56.1 ± 11.4 in PD group. At the time of follow-up, pain scores improved significantly in both groups and were 10.3 ± 8.8 and 10.9 ± 8.6, respectively. CONCLUSION: DPPHR achieves similar results in pain control as PD with a lower complication rate and shorter hospital LOS.

EVALUATION OF RESULTS OF ERAS PROGRAM AFTER PANCREATODUODENECTOMY DEPENDING ON THE TYPE OF GASTROINTESTINAL RECONSTRUCTION.

OBJECTIVE: The aim: To assess the effect of gastrojejunostomy with Braun anastomosis during PD for prevention of DGE in ERAS protocol patients. PATIENTS AND METHODS: Materials and methods: A total of 92 patients from 28 to 75 years were included in this study, who underwent PD with ERAS program. Patients were divided into 2 groups, depending on type of reconstruction - PD with Child reconstruction and PD with gastrojejunostomy with Braun anastomosis. RESULTS: Results: In non-Braun group nasogastric tube was removed on POD 1 in 56 (93.3%) patients and was reinserted later in 4 (6.7%) patients. DGE was observed in 8 (13,3%) patients, which required enteral feeding via nasojejunal tube. In 51 (85.0%) patients feeding was started according to ERAS program without the need for other methods of nutritional support. In Braun group nasogastric tube was removed on POD 1 in all patients after the X-ray control and oral feeding was started. Due to the development of DGE, a nasojejunal tube for enteral nutrition was placed in two cases. In 30 (93,7%) patients peroral feeding was started in accordance to enhanced recovery program. Thus, the frequency of DGE in group II was lower (6.3%), but the difference did not reach statistical significance (p = 0.299). CONCLUSION: Conclusions: The formation of a Braun anastomosis in PD with the use of ERAS program can reduce the frequency of DGE and eliminate the consequences of technical errors. More studies are needed for stronger evidence.

Lung metastasis after pneumonectomy: Is there a place for surgery?

Resection of the contralateral lung after primary total pneumonectomy is a real surgical option for patients with secondary lung disease.