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BACKGROUND The role of gamma-synuclein (SNCG) has been widely examined in malignant conditions due to its possible role in disease progression, but very little information is available on its theoretical function on endometriosis formation. MATERIAL AND METHODS Between January 2016 and December 2016, we collected peritoneal fluid and plasma samples from 45 consecutive female patients, of which 15 were without endometriosis, 15 had minimal to mild endometriosis, and 15 had moderate to severe endometriosis. The statistical power was 0.98. We evaluated SNCG levels in the peritoneal fluid and plasma of patients diagnosed with endometriosis, and we compared them with the levels obtained from disease-free control subjects by using enzyme-linked immunosorbent assay. RESULTS SNCG levels were statistically significantly (1.2-fold) higher in the peritoneal fluid of patients with endometriosis compared to controls (p=0.04). We did not find a significant difference between SNCG levels in the plasma of our endometriosis patients and the control group (p=0.086). However, despite previous data showing very limited expression of SNCG in healthy tissues, we found SNCG in the peritoneal fluid of all of the patients in our healthy control group. CONCLUSIONS Levels of SNCG were statistically significantly higher in the peritoneal fluid of patients with endometriosis compared to disease-free controls, which may indicate its possible role the formation and progression of the disease. Moreover, its biological function should be further investigated due to the conflicting results concerning its expression in healthy tissues.
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Endometriosis/metabolismo , gamma-Sinucleína/análisis , Adulto , Líquido Ascítico/química , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Plasma/química , gamma-Sinucleína/metabolismoRESUMEN
STUDY OBJECTIVE: To present a detailed description of a modified natural orifice specimen extraction (NOSE) colectomy technique. We also report the postoperative outcomes of our prospective case series when compared with conventional laparoscopic bowel resection in a relatively large series of patients. DESIGN: Canadian Task Force classification II-1. SETTING: A university tertiary referral center. PATIENTS: The last 90 consecutive patients in our care with deep infiltrating endometriosis of the bowel are presented in this study. Patients were diagnosed at the 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary. INTERVENTIONS: We performed laparoscopic bowel resection using the transrectal NOSE technique and compared the results of the new operative method (n = 30) with traditional laparoscopic bowel resection (n = 60). MEASUREMENTS AND MAIN RESULTS: The median duration of surgery was 121 minutes in the control group and 96 minutes in the NOSE group (p = .005). According to the Clavien-Dindo classification, we observed a severe, grade IIIb or higher, overall complication rate of 3.3% among all 90 patients. In the control group, anastomosis insufficiency occurred in 3.3% of patients (2/60 cases), and in 1 patient with anastomotic leakage a rectovaginal fistula was observed (1.7%). There was no significant difference in the rates of severe postoperative complications (p = .55). The length of hospital stay in the control group was a median of 7 days (range, 5-13 days), whereas in the NOSE group it was 6 days (range, 3-11 days) (p < .001). CONCLUSION: According to our findings, the use of NOSE colectomy offers a shorter recovery time and can eventually lead to a shorter surgery duration compared with traditional laparoscopic bowel resection.
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Endometriosis/cirugía , Enfermedades del Recto/cirugía , Enfermedades del Sigmoide/cirugía , Adulto , Colectomía/métodos , Endometriosis/patología , Femenino , Humanos , Laparoscopía/métodos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Cirugía Endoscópica por Orificios Naturales/métodos , Complicaciones Posoperatorias , Estudios Prospectivos , Enfermedades del Recto/patología , Enfermedades del Sigmoide/patología , Resultado del Tratamiento , Adulto JovenRESUMEN
Gastrointestinal tract duplications (GSD) are rare congenital abnormalities. Eighty percent of GSDs are diagnosed before the age of two. These lesions can be seen anywhere from the oral cavity to the anus, but ileum is the most commonly affected site. Their clinical presentation is widely variable and unspecific, making the differential diagnosis really hard. Thus despite performing a long line of radiological scans, the diagnosis can be made during a surgery and by the pathologist. A 23-year-old female patient presented at the emergency room (ER) with abdominal cramps. Examinations revealed an unidentified intraabdominal mass. This could not been identified through the next years despite having tons of examinations: intravaginal and abdominal ultrasonographies, CT and MRI scans, colonoscopies, laparoscopies, surgical, gynecological and gastroenterological visits. Amongst the diagnoses were: ovarian cyst, bowel enlargement, Crohn's disease. Due to the latter, she received therapy which temporarily eased her symptoms. But after these, because of abdominal pain, fever and an ultrasonography that showed an intramural abscess in her abdomen, she went through a surgery having an ileocecal resection. Pathological examination showed a duplication of the ileum that might have caused her symptoms all through the years. Despite facing this rare abnormality, it is important to keep this in mind in differentiating abdominal symptoms. It is true that in no case there could be a diagnosis made without surgery, it raises attention to the importance of precise medical history taking and also cooperation between specialties. Orv Hetil. 2018; 159(52): 2217-2221.
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Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/cirugía , Íleon/anomalías , Íleon/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Adulto JovenRESUMEN
INTRODUCTION AND AIM: In the treatment of colorectal endometriosis a multidisciplinary laparoscopic resection is suggested, for this reason the correct selection of bowel infiltration is essential before surgery. PATIENTS AND METHOD: Between 2009 and 2015, 383 sigmoidoscopies were performed in patients with endometriosis. Where mucosal invasion was absent secondary signs (wall rigidity, impression, kinking, pain during the examination, suffusion) were analysed. In endoscopically confirmed cases multidisciplinary surgery was performed, the remaining patients were operated by a gynecologic team only. RESULTS: Endometriosis was endoscopically confirmed in 224 patients (58.49%), 108 of them underwent multidisciplinary operation, the negative 135 cases received gynaecological surgery. Bowel endometriosis was confirmed in 103 out of 108 cases intraoperatively, while in 8 cases of the sigmoidoscopically negative patients bowel infiltration was diagnosed intraoperatively by the gynaecological team. Complete sigmoidoscopy was performed in 43.47% of the cases. Intraluminal endometriosis was found in 4.91%, secondary signs as rigidity in 38.39%, impression in 45.54%, kinking in 57.14%, pain (in cases of examination without narcosis) in 26.06% and suffusion in 3.82% of the cases was found during sigmoidoscopy. Sigmoidoscopic examination has a 92.8% specificity and 96.2% sensitivity in cases of bowel endometriosis. CONCLUSION: Sigmoidoscopy performed by an experienced gastroenterologist is a highly sensitive examination for the diagnosis of bowel endometriosis. Orv. Hetil., 2017, 158(7), 264-269.
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Endometriosis/diagnóstico , Enfermedades del Recto/diagnóstico , Sigmoidoscopía/métodos , Adulto , Endometriosis/complicaciones , Endometriosis/cirugía , Endosonografía/métodos , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Enfermedades del Recto/complicaciones , Enfermedades del Recto/cirugíaRESUMEN
INTRODUCTION: In some surgical wards residents start to do laparoscopic operations using both hands, while in other places they only use their dominant hand, and only start to use both hands later. There are no data at the moment about which method is more effective. METHODS: We divided 20 students with no laparoscopic experience into 2 groups: one group practised one hand at a time (1K), the other group used both hands (2K) during the 5 days. On the last day both groups had to do every exercise with one hand and two hands as well, then they had to do 3 new exercises, which needed both hands. We measured the time taken, and gave points for the videos taken inside the training box based on OSATS. For statistical analysis we used t-tests, p < 0.05 being significant. RESULTS: On the first day, there was no significant difference between the 1K and 2K groups considering the time taken (518/500 s) and the OSATS points (87/84; 54/55 points). Both groups improved in the mean time and points (1K: 52%, 77% 2K: 50%, 70%) as well, but there was no significant difference between them. In the case of new exercises on the last day, there was no difference between mean time (1K: 425 s, 2K: 411 s) and points (53/59 and 56/52), but there was a significant difference considering the points given for bimanuality. CONCLUSION: Based on our study, we cannot exactly state that the bimanuality needed for expert laparoscopic surgery would be easier to learn with immediately practising with both hands.
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Competencia Clínica/normas , Educación Médica/métodos , Internado y Residencia , Laparoscopía/educación , Laparoscopía/métodos , Humanos , Médicos , Desempeño Psicomotor , Factores de TiempoRESUMEN
INTRODUCTION: The incidence of cholelithiasis increases with age, however, there is still little data about the outcomes of cholecystectomy in patients with age of 80 and above. Population ageing presents tremendous challenges for surgeons. AIM: The aim of the authors was to compare emergency and elective cholecystectomies performed in these elderly patients. METHOD: This retrospective study was based on the analysis of operation type, conversion rate, complications, mortality, length of hospital stay of all patients over 80 who underwent cholecystectomy in the last 6 years at the 1st Department of Surgery, Semmelweis University. RESULTS: 69 elective and 51 emergency operations were performed. In the emergency group pancreatitis was found in 9.8%, liver abscess in 14%, and common bile duct stones in 27% of the patients on admission. Laparoscopic cholecystectomy could be performed in 84% of patients in the elective group, while in 17.7% of patients in the emergency group. The length of stay at the intensive care unit was 9.1 and 1 days, while the total length of hospital stay was 12 and 3.6 days for the elective and emergency groups, respectively. In the emergency group mortality was 20% and reoperation was performed in 16% of patients, while at the elective group none of these occurred. CONCLUSION: Laparoscopic cholecystectomy is safe as elective surgery for patients with age of 80 and above. For this reason the authors recommend elective cholecystectomy in this age group.
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Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/estadística & datos numéricos , Colelitiasis/cirugía , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Tratamiento de Urgencia/métodos , Tratamiento de Urgencia/estadística & datos numéricos , Enfermedad Aguda , Factores de Edad , Anciano de 80 o más Años , Colecistectomía/efectos adversos , Colecistectomía/estadística & datos numéricos , Colecistectomía Laparoscópica/mortalidad , Colelitiasis/mortalidad , Enfermedad Crónica , Conversión a Cirugía Abierta/estadística & datos numéricos , Cuidados Críticos/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/efectos adversos , Urgencias Médicas/epidemiología , Tratamiento de Urgencia/efectos adversos , Femenino , Humanos , Hungría/epidemiología , Incidencia , Tiempo de Internación/estadística & datos numéricos , Masculino , Tempo Operativo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: A number of the patients suffer from endometriosis increased in the past decades and the cases have became more serious. The most critical complication of bowel endometriosis is the large bowel obstruction. Up to recently, 16 similar case reports of large bowel endomteriosis causing obstruction, with detailed medical history have been published in the literature in English language. PATIENTS: Since 2007 535 female have been treated in the 1st Gynaecological Department with endometriosis, out of them three patients from emergency surgery in the history because of large bowel obstruction. RESULTS: Symptoms suggesting endometriosis or previous intervention due to endometriosis were detected in 59% (13/21) of the cases. Preoperative ultrasound, computertomography, magnetic resonance imaging did not give correct diagnosis. Colonoscopy was carried out before the primary operation in 61% (13/21) and after the surgery in 24% (5/21) of the cases, but none of them confirmed endometriosis. Although all the patients developed obstruction, only in 5% (1/19) of the patients was the mucosa infiltrated by the endometriosis. CONCLUSIONS: In a young female patient, intestinal obstruction can be caused by bowel endometriosis. Identification of colonoscopic signs (rigidity, impression, kinking) of endometriosis may help to avoid unnecessary extension of intestinal resection. Gynaecologists should take part in the operations. Orv. Hetil., 2016, 157(49), 1960-1966.
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Endometriosis/cirugía , Obstrucción Intestinal/cirugía , Enfermedades del Recto/cirugía , Enfermedades del Sigmoide/cirugía , Adulto , Endometriosis/complicaciones , Endometriosis/diagnóstico , Femenino , Humanos , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Intestino Grueso/patología , Persona de Mediana Edad , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/etiología , Enfermedades del Sigmoide/diagnóstico , Enfermedades del Sigmoide/etiología , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: During laparoscopic partial colectomy the specimen can be extracted transrectally. This technique decreases the invasiveness of the surgery, because the abdominal wall incision is avoided. Premises of a new surgical technique are precise technical description as well as a favourable balance of advantages and disadvantages. In this paper the authors review the technique they apply and analyse their first results. PATIENTS AND METHOD: 45 laparoscopic bowel resections were performed by a multidisciplinary team between 16th April 2014 and 1st November 2015. Indication of surgery was endometriosis, and the specimen was extracted transrectally in 11 patients. Having ligated both bowel ends proximal and distal to the section infiltrated with endometriosis, and the proximal bowel secured with a laparoscopic bulldog. Then the bowel was resected and the specimen was extracted in a camera bag transrectally. A purse-string suture was placed into the proximal bowel end, and the anvil of the circular stapler--which was introduced transrectally--was inserted into the bowel. After closing the rectal stump, the anastomosis was performed with a circular stapler. We used this technique when the upper third of the rectum or sigmoid colon was infiltrated with endometriosis. RESULTS: The difference between the operation time of the two techniques (transabdominal vs. transrectal specimen extraction: 108 min vs. 118 min) was not significant. There was not difference in the WBC count between the first and second postoperative day, and there was not any anastomosis leakage detected either. CONCLUSION: By using the above technique, postoperative infections could have been reduced to minimum. Transrectal specimen extraction did not increase postoperative complication The authors believe this is a safe way of specimen extraction after partial colectomy.
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Endometriosis/cirugía , Cirugía Endoscópica por Orificios Naturales/métodos , Quistes Ováricos/cirugía , Enfermedades del Recto/cirugía , Enfermedades del Sigmoide/cirugía , Enfermedades de la Vejiga Urinaria/cirugía , Adulto , Endometriosis/patología , Femenino , Humanos , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales/efectos adversos , Tempo Operativo , Resultado del TratamientoRESUMEN
INTRODUCTION: Due to significant technical evolution complex surgeries can be performed laparoscopically nowadays. However, laparotomy is needed frequently for the extraction of the specimen, which decreases the advantages of laparoscopy. AIM: The aim of the authors was to analyse and present their experience on the use of natural orifices and abdominal wall defects for extraction of the surgical specimen. METHOD: From 2009 the authors used natural orifices (stomach, vagina, rectum) when viscerotomy was an obligate part of laparoscopic surgery and, in a special gastrointestinal laparoscopic operation, the gate of the inguinal hernia for specimen extraction. RESULTS: In 3 patients benign lesions of the stomach were extracted using gastroscope. In 6 patients with bowel endometriosis, in whom the wall of the vagina was completely infiltrated, the resected bowel was extracted transvaginally, and in 5 patients transrectal extraction of the specimen was performed. In 2 patients the inguinal hernia was used for the surgical specimen extraction after laparoscopic sigmoid resection, and in one patient a single-port was inserted into the gate of the hernia during laparoscopic cholecystectomy. Complications occurred only after transvaginal specimen extraction (rectovaginal fistula in 2 patients). CONCLUSIONS: Use of natural orifices and abdominal wall defects for surgical specimen extraction further decreases the invasiveness of laparoscopic surgery, if indications made appropriately.
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Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Endometriosis/cirugía , Enfermedades Intestinales/cirugía , Laparoscopía , Cirugía Endoscópica por Orificios Naturales/métodos , Manejo de Especímenes/métodos , Adulto , Procedimientos Quirúrgicos del Sistema Digestivo/instrumentación , Femenino , Gastroscopios/estadística & datos numéricos , Hernia Inguinal , Humanos , Masculino , Persona de Mediana Edad , Cirugía Endoscópica por Orificios Naturales/instrumentación , Recto , VaginaRESUMEN
The urachus in the foetus is a fibromuscular duct, which connects the allantois to the bladder and it is usually occluded in the 4-5th gestation months. Incomplete occlusion of the urachus at the time of birth is considered to be physiological, but later it can lead to recurrent discharge and inflammation of the umbilicus. To establish the diagnosis, ultrasound is the first examination of choice. A 19-year old obese female patient presented with umbilical discharge, and a persistent urachus was detected by ultrasound. After incision of the peritoneum the duct was excised from the umbilicus to the dome of the bladder by 3-port laparoscopy where the duct was clipped. The operation time was 38 minutes. The patient required minor analgesia on one single occasion in the postoperative period and was discharged on the first postoperative day. The authors recommend laparoscopic operation for the urachal remnant; the enlarged duct on the ventral abdominal wall can be better detected from the umbilicus to the Retzius spatium with 30-degree camera, and the cosmetic outcome is also more favourable.
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Laparoscopía , Uraco/anomalías , Uraco/cirugía , Femenino , Humanos , Obesidad/complicaciones , Tempo Operativo , Resultado del Tratamiento , Ultrasonografía , Ombligo , Uraco/diagnóstico por imagen , Adulto JovenRESUMEN
INTRODUCTION: Traditional surgeries performed in cases of deep infiltrating endometriosis lead to impaired quality of life. AIM: To summarize the postoperative outcome and to compare the rate of postoperative complications after different therapeutic approaches applied in deep infiltrating endometriosis. METHOD: The authors analized the articles published between March 31, 2004 and March 31, 2015, in the database http://www.pubmed.org using the following keywords: endometriosis, deep infiltrating, nerve sparing, surgery. RESULTS: Non-nerve sparing surgery resulted in temporary urinary dysfunction in 19.1-38.5% of patients, while it occurred in 0.61-33.3% of patients after nerve-sparing surgery. Non-nerve sparing surgical technique resulted in an average of 121 days of need for self-catheretisation. When nerve-sparing surgeries were performed the duration of self-catheterisation varied between 7 to 39.8 days. After nerve sparing surgeries, permanent bladder dysfunction was not detected in any case. CONCLUSIONS: Because of the successful treatment of the patients symptoms and the lower postoperative complication rate, nerve-sparing surgical technique leads to a significant improvement of the quality of life.
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Endometriosis/patología , Endometriosis/cirugía , Procedimientos Quirúrgicos Ginecológicos/métodos , Tratamientos Conservadores del Órgano , Vejiga Urinaria/inervación , Micción , Adulto , Femenino , Humanos , Cateterismo Uretral Intermitente/estadística & datos numéricos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Calidad de Vida , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Vejiga Urinaria/fisiopatologíaRESUMEN
There are two afferent (hepatic artery, portal vein) and one efferent (hepatic veins) systems responsible for the unique circulation of the liver. Given this special form of vasculature, acute, isolated (i.e. involving selectively one particular vessel) vascular occlusions may lead to different, however still life threatening conditions. Hence, it is essential to recognize these anomalies in order to preserve the healthy state of both the liver and the patient's lives. Acute circulatory failures are dominantly associated with liver surgery. Adequate therapy can only be provided promptly, if the clinician is well aware of the peculiarities of these conditions. The aim of this study is to overview the etiology and symptoms of these clinical conditions; furthermore to offer technical proposals for the required diagnostic and therapeutical steps via case reports. Furthermore, hepatic injury, caused by ischemia-reperfusion secondary to total vascular occlusion (Pringle maneuver) used in hepatic surgery is outlined.
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Arteria Hepática/cirugía , Venas Hepáticas/cirugía , Circulación Hepática , Hígado/irrigación sanguínea , Sistema Porta/fisiopatología , Sistema Porta/cirugía , Trombosis de la Vena/cirugía , Adulto , Anciano , Biomarcadores/sangre , Circulación Colateral , Constricción Patológica/cirugía , Femenino , Hepatectomía , Arteria Hepática/patología , Arteria Hepática/fisiopatología , Venas Hepáticas/fisiopatología , Humanos , Hígado/patología , Masculino , Persona de Mediana Edad , Necrosis , Vena Porta/fisiopatología , Vena Porta/cirugía , Periodo Posoperatorio , Reoperación , Daño por Reperfusión/prevención & control , Factores de Tiempo , Tomografía Computarizada por Rayos X , Trombosis de la Vena/fisiopatologíaRESUMEN
INTRODUCTION: The number of patients operated on with endometriosis increases, the urological organ and the bowels are involved in 10-40% of the cases in addition to the gynaecological organs. PATIENTS AND METHODS: Sigmoideoscopy detected bowel endometriosis in 224 patients from 383 patients with endometriosis, and 127 patients were operated on from 14.07.2009 to 13.01.2014 at the 1st Gynaecological Department of Semmelweis University, Budapest, Hungary. All the operation was made by the same gynaecologist and surgeon team. RESULTS: Segment resection of the bowel was performed in 120 patients, local resection in two patients and shaving in another two cases. The involved part of the bowels were the rectum at 46 patients, rectosigmoid in 68, sigmoid bowel in 30, coecum in 4, appendix in 2 and the small intestine in 2 patients. Bladder resection was carried out in 9 patients, ureter resection in two patients and ureterolysis in 26 cases were done due to infiltration of the urological organs. The laparoscopic operation needed to be converted on one single occasion due to bleeding from the epigastric artery, and a laparoscopic suture of the anastomosis was applied for bleeding in another patient. The specimen was extracted transvaginally in 16 patients and transanally in 13 patients. Anastomotic leakage was detected in two patients and rectovaginal fistula in four patients. All reoperations (creation and closing of the stoma) were done laparoscopically. CONCLUSIONS: The treatment of the bowel endometriosis is suggested with segment resection by multidisciplinary team, where the invasivity can be decreased by transanal specimen extraction.
RESUMEN
273 patients underwent elective surgical treatment for benign liver lesions at the 1st Surgical Department of Semmelweis University, Budapest, Hungary between 2004 and 2014. Laparoscopic (LAP) interventions were performed in 83 cases. Cyst fenestration in 52, and hepatic resection in 31 cases. LAP liver resections were set against to open surgery of paired group of patients with comparable demographic and clinical parameters. Data revealed that the operative time in LAP group (113.7 min) was significantly longer than that in the open surgery group (89.5 min). The average postoperative length of hospital stay was shorter after LAP surgery (5.8 vs 9.1 days). There was no postoperative complication in the LAP group, two wound infections and one biliary collection were treated by ultrasonic drainage in the open group. Three patients were given blood transfusion in the LAP, four in the open group. Operative mortality was zero, and no reoperation required. The surgical technique which is described in detail in the text enables safe resection of segments 7-8 which are difficult to approach. Our data support the safety and feasibility of laparoscopic liver resection after adequate preoperative investigations.
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The authors report a case of a 27-year-old patient who had deeply infiltrating endometriosis involving the rectum, sigmoid colon and the rectovaginal septum, which was removed by laparoscopic surgery. During surgery the affected bowel segment, the deeply infiltrating nodule of the rectovaginal septum and the posterior vaginal wall were resected and the 12 cm long specimen was removed transvaginally. Postoperative bleeding was noted in the first postoperative day, which was treated laparoscopically, as well. This case history confirms data from the literature showing that the natural orifice specimen extraction procedure can widely be applied during operations for deeply infiltrating endometriosis and that laparoscopic anterior resection is a safe and feasible method for the treatment of colorectal deeply infiltratnig endometriosis. Moreover, perioperative complications can be treated by means of laparoscopic surgery.
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Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Endometriosis/cirugía , Intestinos/cirugía , Laparoscopía , Cirugía Endoscópica por Orificios Naturales , Vagina , Adulto , Femenino , Humanos , Laparoscopía/métodos , Reoperación , Resultado del TratamientoRESUMEN
INTRODUCTION: Deep infiltrating endometriosis is a particular form of endometriosis that penetrates the peritoneal surface or it reaches the subserosal neurovascular plexus. AIM: The aim of the authors was to analyze the results of segmental colorectal resections performed for deep infiltrating endometriosis. METHOD: Between 2009 and 2012, 50 patients underwent segmental rectum or/and sigmoid resection for endometriosis. RESULTS: 21 patients had ultralow rectal resection and 29 patients had low colorectal anastomosis or anterior resection. Concomitant intervention in other organs was required in all cases, including gynecologic procedures (n = 50), additional gynecologic (n = 47), vesical (n = 9) and ureteral (n = 18) resections. The mean number of endometriosis lesions was 2.4±1.8 per patient. In all patients fertility was preserved. Severe surgical complications (Clavien-Dindo stage III or more severe) occurred in 3 patients (6%). CONCLUSIONS: The results confirm that segmental bowel resection is an efficient and safe method for the treatment of deep infiltrating colorectal endometriosis. Orv. Hetil., 2014, 155(5), 182-186.
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Laparoscopic (LAP) colorectal surgery has become increasingly popular worldwide. Large comparative studies demonstrate the benefit of the method, but data about routine application are relatively moderate. This study presents the results of laparoscopic colorectal linterventions in a non-selected patient population, who were admitted to the 1st Department of Surgery, Semmelweis University between January 2004 and December 2011. 393 patients underwent LAP surgery. In 333 cases the malignant tumor indicated surgery. T3 tumor rate was 62.7%. Synchronous liver metastases were detected in 17 cases, three of them were single and operable, but 14 cases were multiplex and inoperable. Bowel was successfully resected in all cases. Complication rate was 9.9 percent. In-hospital mortality was 2.0%. Length of hospital stay of non-complicated cases was 6.7 days. In 9 cases single incision intervention was performed, with an average length of hospital stay of four days. Rate of sphincter preserving rectal resections were 87.2%. 59 (15.0%) patients underwent conversion from LAP to open surgery. Operating time decreased by time, but both OP time and conversion rate were tipically determinded by the surgeon's skill. LAP surgery was found to be useful for all kind colorectal diseases requiring elective resection. Application of LAP method requires organized training programs.
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Colectomía/métodos , Neoplasias Colorrectales/cirugía , Laparoscopía , Adulto , Anciano , Colectomía/efectos adversos , Neoplasias Colorrectales/mortalidad , Conversión a Cirugía Abierta , Procedimientos Quirúrgicos Electivos , Femenino , Mortalidad Hospitalaria , Humanos , Perforación Intestinal , Intestino Delgado/lesiones , Tiempo de Internación , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Tempo Operativo , Peritonitis/etiología , Complicaciones Posoperatorias/epidemiología , Reoperación , Índice de Severidad de la Enfermedad , Dehiscencia de la Herida OperatoriaRESUMEN
INTRODUCTION: Operating room is not the ideal place to acquire laparoscopic skills since patients can be put at risk and it is also relatively expensive. Using training boxes seems to be a more appropriate way of teaching and learning the technique, but there is little data about measuring the technique of experienced specialists and comparing their results with residents. METHODS: At the 1st Department of Surgery, Semmelweis University we tested 30 residents and 25 specialists in general surgery and urology on MENTOR® training box. Before training, all participants completed a questionnaire on professional experience, previous usage of training boxes, virtual simulators, and video games, and whether they played a musical instrument earlier. Subjects were asked to complete in a defined time limit 3 of the Fundamentals of Laparoscopic Surgery tasks (which is required for American surgical residents for surgical board examination), and 3 tasks decided by us. Linear regression analysis (ANOVA table) was used to evaluate the data. RESULTS: 16% of the specialists and 6.66% of the residents completed all tasks within time limit. Statistically significant correlation (p < 0.05) was demonstrated between the number of previous laparoscopic surgeries and task completion time, while there were no significant correlations between other factors, which may influence laparoscopic technique and task completion time. CONCLUSIONS: Training boxes are suitable for developing eye-hand coordination and bimanuality, as well as for learning instrument handling. Nonetheless, residents acquire most of their laparoscopic surgical skills on patients in Hungary, yet. For this reason there is a need for organized training opportunities.
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Competencia Clínica/estadística & datos numéricos , Competencia Clínica/normas , Simulación por Computador , Internado y Residencia/estadística & datos numéricos , Laparoscopía/educación , Tempo Operativo , Médicos/estadística & datos numéricos , Adulto , Análisis de Varianza , Diseño de Equipo , Femenino , Cirugía General , Humanos , Hungría , Internado y Residencia/normas , Modelos Lineales , Masculino , Persona de Mediana Edad , Médicos/normas , Especialización/normas , Encuestas y Cuestionarios , UrologíaRESUMEN
BACKGROUND: Single-port surgery was developed by the evolution of the laparoscopy. The advantage of this new method is mainly cosmetic, but the risk of the hernia-owing to the larger port-increased. CASE REPORT: A 71-year-old man was admitted with a left lateral inguinal hernia and gallbladder stones. After preparation of the sac of the hernia, a single-port was inserted into the lateral ring and a cholecystectomy was performed. The operation was completed by the reconstruction of the abdominal wall using a polypropylene mesh. The total operating time was 85 minutes. CONCLUSION: In the case of the combined operation, the defect of the abdominal wall could be used as a location of the single port, and the trauma of the abdominal wall could be avoided. This is the first publication about single-port cholecystectomy where the ring of the inguinal hernia was used as a placement site of the single port.
Asunto(s)
Colecistectomía Laparoscópica/métodos , Colelitiasis/cirugía , Hernia Inguinal/cirugía , Anciano , Humanos , MasculinoRESUMEN
Single port laparoscopic surgery became popular all over the world, and cholecystectomy represents the most frequent intervention with this technique. We compared transumbilical single port laparoscopic cholecystectomies (SILS) to conventional three-port laparoscopic cholecystectomies (LC), which were performed by the same surgeon between 2008-2010. As regards SILS cases, they represent a non-selected series. Transabdominal sutures were not applied in any of those, but one additional 5 mm port was inserted in two SILS cases. Only straight instruments were used in all but two SILS cholecystectomies. Mean age of patients was lower in the SILS group, however male:female ratio and BMI were similar. While none of the procedures were converted in the SILS group, one needed to be done so in the LC patients. One of the SILS patients underwent a transumbilical laparoscopic wash-out for an intrabdominal haematoma, which developed due to non-surgical reasons. Mean operative time and postoperative hospitalisation was 75.9 ± 25 minutes and two days in the SILS group, while 55.7 ± 17 minutes and 2.8 days in the LC group, respectively. We concluded that transumbilical single port cholecystectomy can be performed safely by using conventional straight instruments. We could not identify any publication about non-selected SILS cholecystectomy series in the English language literature.