Management of bile duct injuries following laparoscopic cholecystectomy: long-term outcome and risk factors infuencing biliary reconstruction.

BACKGROUND: Bile duct injury following cholecystectomy remains a severe complication with major implications for the patient outcome. AIM: To assess the outcome of surgical treatment and study the risk factor infuencing biliary reconstruction in patients with bile duct injuries following laparoscopic cholecystectomy. METHODS: Between January 2005 and December 2010, 43 patients with bile duct injuries following laparoscopic cholecystectomy were treated to our center. According to Strasberg classification, the types of injuries were as follows: type A in 7 patients (16.28%), type D in 4 (9.3%), type E1 in 9 (20.93%), type E2 in 11 (25.58%), type E3 in 10 (23.25%),and type E4 in 2 (4.65%) patients respectively. Management after referral included endoscopic sphincterotomy in patients with minor lesions (Strasberg type A) and Roux-en-Y hepaticojejunostomy in 36 patients with major duct injuries(Strasberg type D and E). 55.55% of patients with major bile duct injuries have endoscopic or surgical attempts of repair sprior to referral. In case of biliary peritonitis or acute cholangitis, the reconstruction was preceded by prolonged external biliary drainage. RESULTS: All minor lesions were successfully treated endoscopically,with outstanding long term results. For patients with major duct injuries, the postoperative mortality and morbidity rate were 5.55% and 25%, respectively. After a median follow-up period of 34.1 (range, 12-68) months, 30 patients(88.23%) remain in good general condition (using McDonald classification) and 4 patients (11.77%) developed a late anastomotic stricture. Multivariate analyses have identified postoperative biliary leak (p=0.012) as an independent predictor factor for the occurrence of late anastomotic stricture. CONCLUSIONS: Minor bile duct injuries can be successfully treated endoscopically if proper abdominal drainage is maintained. Roux-en-Y hepaticojejunostomy is feasible and safe with contained morbidity and durable results even when previous surgery has failed. Postoperative biliary leak is a significant predictor for poor long term outcome.

Risk factors for complications after duodenopancreatectomy. Initial results after implementing a standardized perioperative protocol.

INTRODUCTION: During 1993-2008 period, in the Surgical Clinic III were conducted several retrospective studies, in order to identify risk factors for complications after cephalic duodenopancreatectomy(DP). As a result of these studies, a preoperative protocol was developed for preparation of patients proposed for DPC, as well as a number of intraoperative technical changes in order to improve postoperative morbidity and mortality. Implementation of the protocol was gradually and inomogenic done in our service. METHODS: The study is prospective, conducted in 2009-2012, ina group of 180 patients and aims to evaluate immediate results after DPC for periampular malignancy, looking to analyze the effects of implementation of the protocol mentioned above.We analyzed the rates of complications (pancreatic fistula,blunt pancreatitis, bleeding from the pancreatic blunt, delayed gastric emptiness), and the factors that might influence their occurrence. RESULTS AND CONCLUSIONS: of the 180 patients, 10 (5.5%) developed pancreatic fistula and 24 (13.3%) had delayed gastric emptiness. Among the factors that have been significant associated with these complications we mention: the pancreatico-jejunalanastomosis and gastro-jejunal transmesocolic assembly. With the implementation of the protocol, the risk factors previously identified in retrospective studies performed in our service(elevated transaminases, experienced surgical team, etc.) have lost significance, but they have not disappeared entirely, due to fact that the conduit proposed was not entirely followed. We believe that the homogeneous application of a perioperative guide, together with a standardized surgical technique, will lead to improve immediate results after DP.

Surgical outcome of inflammatory bowel disease - experience of a tertiary center.

UNLABELLED: BACKGROUNDS/AIM: Despite advances in medical treatment, a large number of patients with inflammatory bowel disease(IBD) require surgery. We aim to evaluate the efficacy and outcome of surgical interventions in patients with chronic inflammatory bowel diseases. MATERIAL AND METHODS: We retrospectively analysed the medical records from 221 patients admitted to our institution between 2009-2012 with the diagnosis of IBD. Out of these patients, 55 (24.88 %) were diagnosed with Crohn's disease,while the remaining 166 patients (75.11%) had ulcerative colitis. RESULTS: Seventeen of 55 patients with Crohn's disease (30.91%)required surgical management before or during this period. Nine with disease proximal to the transverse colon underwent segmental resections (enteral or colonic) with primary anastomosis, without morbidity. The other 8 patients, with disease distal to the transverse colon, underwent segmental colonic resections (two with primary anastomosis, three with stoma formation) or major colonic resection- subtotal colectomy with ileostomy (1 case) and total proctocolectomy with ileostomy(2 cases). Sixteen of 166 patients with ulcerative colitis(9.64%) required surgery before or during this period. The surgical procedure used included total proctocolectomy with definitive ileostomy (3 cases) and total colectomy with ileostomy(13 cases). 7 of the 13 patients had restorative surgery after total colectomy, 1 remaining with definitive ileostomy due to short vascular pedicle and 5 patients refused restorative surgery. Median daily stool frequency after reconstructive surgery was 7(range 3-12). CONCLUSION: For patients with Crohn's disease proximal to the transverse colon, limited resection with primary anastomosis is safe. Major colonic resection (subtotal colectomy or proctocolectomy)is indicated if the disease is located distal to the transverse colon and primary anastomosis should be avoided. Due to unsatisfactory quality of live after reconstructive surgery(stool frequency remains high), total proctocolectomy with end-ileostomy remains a viable alternative for patients with ulcerative colitis.

Management of bile duct injuries secondary to laparoscopic and open cholecystectomy. The experience of a single surgical department.

UNLABELLED: Cholecystectomy is one of the most performed surgical interventions in general surgery. Laparoscopic cholecystectomy was associated with an increasing occurrence of biliary ducts lesions. The aim of this study is to draw the attention towards the permanent risk of these kind of complications, the curative difficulties and identifying the best therapeutic solution in order to obtain favorable results on long term. METHOD: There were retrospectively and prospectively analysed all the cases with diagnosis of iatrogenic biliary ducts lesion hospitalized and operated during 1987-2008 in the Surgical Clinic No 3 Cluj Napoca. RESULTS: The yearly distribution showed an increasing number of biliary lesions operated in the Surgical Clinic No 3 Cluj-Napoca. 81% of the iatrogenic lesions in our study occurred postlaparoscopic cholecystectomy, and 19% secondary to an open cholecystectomy. One hundred thirty-six patients had major biliary lesions (D, E classes according to Strasberg Soper) and 47 patients had minor lesions (A-C classes). The medium hospitalization range was 17 days. Eighty - three patients (45.3%) needed one, two or three surgical interventions before the complete cure of the lesions. The most frequent complication was plague suppuration (12.5%). The cardio-renal-pulmonary complications were present in 8.7% of the patients and the intra-abdominal abscess in 3.8% of the patients. The anastomotic fistula was present in 11% of the operated patients and 6% global mortality. CONCLUSIONS: The iatrogenic lesions of the biliary ducts are characterized by a complicated evolution, with series of interventions and progressive evolution to biliary stenosis. Delaying the final biliary treatment and the high number of interventions performed before patients were referred to hepato-biliary specialised centres lead to an increasing morbidity and hospitalization costs.

Intestinal obstruction secondary to appendiceal mucocele.

Few cases of intestinal obstruction complicating an appendiceal mucocele have been recorded. We report the case of a young woman who presented to the emergency room with diffusely abdominal pain, nausea, vomiting and disruption of bowel movements. Her abdomen was mildly distended and tympanic. A flat film of the abdomen revealed dilated small bowel loops with air-fluid levels suggestive of small bowel obstruction. She also had leukocytosis. An emergency operation was performed under the diagnosis of intestinal obstruction. The intraoperatory findings showed a tumoral appendiceal mass permeated into the ileum in two distinct points, causing an enteral stenosis. We performed an appendectomy "en bloc" with two enteral loop resections of the permeated ileum followed by two T-T enteral anastomoses. The pathologic examination revealed appendiceal mucinous cystadenoma. Postoperative course was favorable, the patient being discharged on the seventh postoperative day. Postoperative checks performed at 3, 6, 12 and 24 months (including colonoscopy) have not showed pathological changes.

[Evaluation of prognostic factors for colon cancer]. / Evaluarea factorilor de prognostic în cancerul de colon.

INTRODUCTION: Colon cancer represents a major health problem in the world. The outcome of newly diagnosed cases predominantly relies on stage as defined by the UICC-TNM and American Joint Committee on Cancer classifications. AIMS: The aim of this retrospective study was to identify the additional prognostic factors for patients with colon cancer. PATIENTS AND METHODS: We retrospectively analyzed the incidence and significance of 8 clinical and pathological factors in 225 patients treated over a 2-year period in Surgery Clinic No. III, Cluj-Napoca. In order to avoid selection bias, all cases with a prior diagnostic of colon cancer and intervention for recurrence or metastasis, as well as cases lacking more than 20% of necessary datawere excluded. The candidate variables were analyzed using the Cox Proportional Hazards Model in order to select those who influence the outcome. RESULTS: The overall 5-year survival rate was 42%. Patients treated with resection of the primary tumor had a survival rate of 50%, ranging from 82% in patients with stage I malignancy to 11% in the presence of metastatic disease. 21% of all patients underwent emergency operation for obstruction or perforation but this did not significantly influence survival (p = 0.1). TheTNM stage of the tumor (HR = 1.2-8.4), grade of tumor differentiation (HR = 2.1) and perineural invasion (HR = 1.8) were independent negative prognostic factors. Venous invasion and status of resection margins were found to influence the outcome on univariate analysis, but were discarded when integrated in the multivariate model. The number of lymph nodes analyzed (p = 0.9) and the tumor location (p = 0.3) did not significantly affect the outcome of patients. CONCLUSION: These results suggest that the prognosis of newly diagnosed cases of colon cancer is influenced by the TNM stage, the degree of tumor differentiation and the presence of perineural invasion.

Perforated appendix with periappendicular abscess in a inguinal hernia sac--Amyand's hernia.

Amyand's hernia is a rare form of inguinal hernia, where the appendix is included in the hernia sac. We present the emergency case of an 81-year-old patient with right inguinal pseudo-tumor, accompanied by marked local pain, nausea, low grade fever and bowel disorders. Emergency surgery is indicated due to a suspected incarcerated inguinal hernia with imminent strangulation. The intraoperatory findings reveal the presence of a periappendicular abscess as the cause of gangrenous appendicitis, perforated in the right indirect inguinal hernia sac. The practice includes the evacuation of the abscess, appendectomy and surgical cure of the inguinal hernia--Bassini's procedure, Douglas drainage and subcutaneous drainage. The postoperative outcome was favorable, the patient being discharged on the fifth postoperative day. Postoperative checks performed at 3 and 9 months have not revealed the presence of a hernia recurrence.

[Risk factors for anastomotic leakage following colorectal resection for cancer]. / Factorii de risc ai fistulelor anastomotice dupa chirurgia neoplaziilor colo-rectale.

PURPOSE: To identify the risk and prognosis factors and their predictive value for anastomotic leakage after colorectal resections following cancer. PATIENTS AND METHODS: 1743 consecutive patients who underwent colic resections or rectal resections for colo-rectal cancer between 1996-2005 in Surgical Clinic no. 3 (Cluj-Napoca, Romania) were retrospectively analysed. RESULTS: A total of 54 (3.09 percent) anastomotic leaks were confirmed. Univariate analisys showed that the preoperative variables significantly associated with anastomotic leakage included weight loss, smoking, cardiovascular disease, lung disease, hypoproteinemia, diabetes, anemia, leukocitosis, presence of two or more underlying diseases. Use of alcohol, cerebrovascular disease, bowel preparation, mode of antibiotic prophylaxis, type of handsewn anastomosis, tumor location, tumor stage and tumor histology were nonsignificant variables. Hipoproteniemia (S - proteins < 60g/dl) and anemia (S Hb < 11) remained significant in logistic regression model. CONCLUSIONS: Our study shows that a value of S-proteins lower than 60 g/l and s-Hb lower than 99 g/l can be consider as predictive marker for anastomotik leak deshiscence.

[Jejunal ischemic ulcer with perforation: a case report]. / Ulcer jejunal de tip ischemic, perforat. Prezentare de caz.

Ulcerative ischemic lesions of the small bowel represents a rare abdominal pathology. We present the case of a 68-year-old male who was admitted to our hospital for abdominal pain, nausea and vomiting. Ultrasound examination followed by upper endoscopy raised up the suspicion of a jejunal ulcerative perforated lesion. Surgery confirmed the diagnosis, revealing the jejunal ulcer, perforated and blocked by the adjacent enteral loops. Ischemic etiology of the ulceration was indicated by the mesenteric thrombus. The anatomopathologic finding together with the clinical and imagistic examinations lead us to the diagnosis of thromboangiitis obliterans, cause of the mesenteric ischemia; the future problems regarding this case are the long term follow up, in order to be able to recognise the visceral ischemic recurency that might occur.

[Non-ulcerous duodenal perforations: a clinical analysis of 23 cases]. / Perforatiile neulceroase ale duodenului: analiza a 23 de cazuri.

Non-ulcerous duodenal perforations are a rare and seldom studied pathology. The present retrospective study analyses a group of 23 patients, over a 10 year period (Jan 1st 2000 - Dec 31st 2009) with this pathology. The most frequent etiology was iatrogenic (52.17 % after ERCP and 17.39% after upper gastrointestinal endoscopy). Other rare etiologies included were tumoral perforations, penetrating wounds, and ingestion of foreign bodies. The lesions vary from millimetric perforations to total necrosis of the wall of a duodenal segment and are often associated with other complex lesions. The overall mortality was 52.17%, a little lower for the post ERCP injuries (40%). Usually the iatrogenic lesions are diagnosed earlier (ex. 54.54% of the post ERCP lesions undergo surgery during the first 24 h), probably increasing the chance of surviving. 43.47% of cases undergo surgery in the condition of severe sepsis, with multiple organ failure, thus aggravating the prognosis. Sometimes the patient required multiple interventions (with a maximum of 8 in our group). In 26% of the cases the primary intervention was just paraduodenal and/or retroperitoneal drainage, suture of the duodenum (6 cases - 26%), usually under the protection of a gastro-enteroanastomosis (4 cases - 17.39%), suture of the duodenum around a decompression tube (26%), sometimes suture of the duodenum with a jejunal serous patch or duodeno-jejunal anastomosis. The bile drainage and the jejunostomy were associated sometimes. The procedures in this pathology have a significant morbidity, with a high rate of reinterventions (30.4%).

[Improvement in the quality of life for patients with adjustable gastric banding: initial results]. / Ameliorarea calitatii vietii la pacientii cu inel gastric reglabil: rezultate initiale.

UNLABELLED: The aim of the study was to evaluate the improvement in quality of life for patients that have undergone the laparoscopic gastric banding, using the BAROS and Moorehead-Ardelt II questionnaires. METHODS: We selected a 20 patient group (65% women) that underwent this surgical procedure in our clinic. The initial average weight was 123.45kg, and the body-mass index of 42.36. The average age was 29.25 years. The pars flaccida technique was used in 18, and the perigastric approach in 2 cases. RESULTS: No complications or intraoperative accidents occurred. The mean operation time was 115.5 minutes. Elective conversion was needed in one case with a BMI of 55. The average hospital stay was of 3.2 days. The follow-up was conducted at least through phone in 95% of cases, and its average duration was of 10 months. The only postoperative complications were infections of the subcutaneous port (5 cases - 25%) which needed removal of the port, but not of the banding. The average loss of excess weight was 48.23%. Using the BAROS score to determine the overall improvement of quality of life, 30% of the patients scored as "Very Good", 50% as "Good", 20% as "Fair". Using the Moorehead-Ardelt QLQ II score, 65% scored as "Very Good", 30% as "Good" and 5% as "Fair". CONCLUSION: The laparoscopic adjustable gastric banding significantly improves the quality of life for most patients with this procedure.

[Surgical management of malignant large bowel obstructions]. / Managementul chirurgical in urgenta al ocluziilor prin cancere colonice si rectale.

INTRODUCTION: Despite significant progress, the management of acute colonic obstruction still remains a challenging problem. The purpose of this study was represented by the evaluation of the clinical results of different techniques of resection for malignant colorectal (primary or staged) obstruction. METHODS: We performed a non-randomized clinical study. 590 patients with malignant colorectal occlusion who underwent surgery treatment an 3rd Surgical Clinic Cluj-Napoca between 1996-2005 were included. RESULTS: Patients with large bowel obstruction underwent one-stage primary resection with anastomosis in 267 cases or staged interventions in 323 cases. The groups were matched in: age, sex, comorbidities, tumor staging, serum preoperative levels of hemoglobin and proteins. The analysis of mortality and morbidity following surgical treatment for large bowel obstruction returned no significant difference among the two groups (p > 0.05). Moreover, the presented results showed a higher incidence of mortality (11.45% vs 9.33 %), morbidity (25.38% vs 14.6%) and increased hospitalization period (p = 0.029) among the patients that undergone seriate resections. CONCLUSIONS: One stage primary resections with anastomosis of the large bowel can be performed safely in case of emergency whenever patient comorbidities and local conditions do not stand as major restrictions.

Laparoscopic surgery for the treatment of colon cancer: the new standard?

OBJECTIVE: Colon cancer is a major health problem worldwide with an overall 5-year survival rate of < 50%. Despite advances in the field of oncology proving that adjuvant chemotherapy may improve the outcome, the only treatment with curative intent is represented by surgical resection of the tumor. Over the past 30 years, surgical techniques for the treatment of colon cancer have improved considerably. Major doubts regarding the radicality of the resection and the long-term outcome have been overcome lately. The main objective of this study was to determine the feasibility of laparoscopic surgery for the treatment of colon cancer. MATERIALS AND METHODS: Our goal with this paper was to conduct a narrative review of the literature about laparoscopic treatment in colon cancer and outline the essential principles of the procedure. RESULTS: We found that laparoscopic resection has advantages over open surgery. These advantages include a shorter hospital stay, reduced incidence of surgical site infection, earlier return of bowel movements, and less immune suppression. As surgical centers with higher volume have very low complication rates, patients proposed for laparoscopic colonic resection for cancer should be referred to these hospitals. CONCLUSIONS: Laparoscopic surgery is an important option in the radical treatment of colon cancer that can be used routinely and safely.

Multimodal therapy for hepatocellular carcinoma: the role of surgery.

OBJECTIVE: Liver cancer is one of the widest spread malignancies in the world and its incidence is still on the rise. The surgical resection of liver cancer has become a widely performed procedure with considerably improved outcomes, low mortality rate, transfusions, and post-op bed stay. MATERIALS AND METHODS: Our goal with this paper was to conduct a narrative review of the literature in regard to the surgical treatment of hepatocellular carcinoma (HCC). RESULTS: There are various modalities of treatment for the HCC, e.g., hepatic resection, LT, or radiofrequency ablation (RFA) - the selection of a specific treatment regimen plays a decisive role in the survival rate of the patient and this, in turn, is guided by factors like size and distribution of lesion and the stage of malignancy. A more efficient patient selection for each treatment increases the survival rate of the patients in each subgroup. CONCLUSIONS: Surgical procedures play a crucial role in treatment of hepatocellular carcinoma as part of a multimodal therapy.

[The evaluation of enzymatic and biochemical changes in radiofrequency liver resections]. / Evaluarea în dinamica a dezechilibrelor biochimice si enzimatice dupa rezectiile hepatice prin radiofrecventa.

INTRODUCTION: Liver resection represents the only curative treatment option in liver tumors. There are many bloodless techniques that can be used in liver surgery. The main advantage of these techniques is represented by low incidence of hemorrhagic accidents. Still, these techniques are controversial due to induction of important enzymatic changes in the postoperative period. This study analyses the dynamic of enzymatic and biochimic changes that occurs after liver resections by radiofrequency. MATERIALS AND METHODS: We designed a prospective study that includes all patients (57) with resected liver tumors by means of radiofrequency (Habib 4X) technique in Surgery Clinic no. 3 Cluj-Napoca, Romania. RESULTS: We report the increase levels of K, LDH, TGO, TGP, BT, BD, leukocites in 24-48 hours post-resection. Age more than 60 years was corelated with lower peaks of LDH and white blood cells. (p = 0.021) and high levels of serum urea (p = 0.023). DISSCUSIONS: We report lower transaminase values than other similar findings. Similar to other findings the enzymatic changes return to normal after 6 days from the surgery. CONCLUSION: We agree the idea of using RF liver resection in selected cases only and not hazarduos.Despite these benign enzymatic changes RF has a major advantage of bloodless liver transeection and should be used whenever it's feasibile.

[Laparoscopic treatment of a large trichobezoar in the stomach with gastric perforation and abdominal wall abscess]. / Tratamentul laparoscopic al unui tricobezoar gastric de mari dimensiuni complicat cu perforatie gastrica blocata in peretele abdominal anterior.

Trichobezoar represents a mass of swallowed hair inside the stomach. Here we report a 17-year-old girl who presented in our department with symptoms of gastric ulcer. Ultrasound examination followed by upper endoscopy revealed a large trichobezoar in the stomach with simultaneous gastric perforation. Laparoscopy also revealed a penetration into the anterior abdominal wall accompanied by abscess at this level. We performed a laparoscopic gastrotomy with trichobezoar extraction and laparoscopic treatment of perforation and abdominal wall abscess. The postoperative evolution was normal and the patient was discharged on the fifth postoperative day. We show that laparoscopic approach may be safely used in the treatment of the large gastric complicated trichobezoar. Several laparoscopic approaches were described for the treatment of tricobezoar and its complications but as far as we know this is the first report of laparoscopic treatment of large tricobezoar and associate gastric perforation.

[Liver resection for benign hepatic lesion: mortality, morbidity and risk factors for postoperative complications]. / Hepatectomiile pentru leziuni focale hepatice benigne: mortalitate, morbiditate si factorii de risc corelati cu complicatiile postoperatorii.

UNLABELLED: The aim of this study was to evaluate the result of liver resection for benign hepatic lesion and to determine the risk factors for postoperative complication. Between January 2001 and December 2006 (6 years), a total of 50 patients with benign hepatic lesion underwent hepatic resection and were retrospectively reviewed. The sex ratio was M/F=31/19 with a mean age of 44 years (range 2-74). The diagnosis was: hydatid cyst in 24 patients (48%); hemangioma in 14 patients (28%), focal nodular hyperplasia (FNH) in 6 (12%), hepatic adenoma in 3 cases (6%), and hepatoblastoma in 3 patients (6%). Fourty patients (80%) had symptoms prior to surgery (mainly abdominal pain). The abnormalities were located in 34 cases on the left liver (II-IV Couinaud segments) and in 16 cases on the right liver (V-VIII Couinaud segments). Twenty-nine patients (58%) underwent atypical resections, 4 underwent left hemihepatectomy (8%), 16 underwent left lobectomy (32%) and 1 patient was treated by segmentectomy (2%). Median operating time was 108 minutes (range 60-220) and the median blood lost was 310 ml range (30- 1500). The morbidity rate was 18% (9 patients). Independent risk factors associated with the development of postoperative complication were intraoperative blood lost more than 1200 ml (p=0,015; OR=1,7) and the operating time more than 150 minutes (p=0,048; OR=1,09). There was no mortality. The mean postoperative hospitalization was 7,86 days with the range 3-23 days. CONCLUSION: 1. Liver resections for benign hepatic lesion performed in specialized centers are safe and efficient, with low morbidity and mortality. 2. Postoperative morbidity was related to the intraoperative blood lost more than 1200 ml and to the operating time more than 150 minutes.

[Management of colorectal resections for treatment of neoplastic intestinal occlusions. Experience of surgery clinic No III, Cluj-Napoca]. / Managementul rezectiilor colorectale în tratamentul ocluziilor intestinale neoplazice. Experienta Clinicii Chirurgie III Cluj-Napoca.

PURPOSE: We analyzed the clinical results of different techniques of resection for malignant colorectal (primary or staged) obstruction. METHODS: The subjects of this retrospective nonrandomized clinical study were 165 patients with malignant colorectal occlusion who underwent surgery treatment in our Department between 2002-2006. Patients with peritonitis or treated by means of permanent colostomy, palliative anastomosis, primary Hartman resection and rectal excision were excluded. RESULTS: Patients with large bowel obstruction caused by obstructive malignant colorectal lesions underwent either one-stage primary resection with anastomosis (77 patients) or staged interventions (88 patients). There were no differences in age, sex, comorbidities, tumor staging, serum preoperative levels of hemoglobin and proteins between the two groups of patients defined by the different surgical techniques. Regarding mortality and morbidity following surgical treatment for large bowel obstruction no significant difference among the two groups (p > 0.05) or the fistula rate (p = 0.435) was obtained. Moreover, results showed a higher incidence of mortality (11.8% vs 7.8%), morbidity (13.6 vs 10.4) and increased hospitalization period (p = 0.03) among the patients that undergone series resections. CONCLUSIONS: One stage primary resections with anastomosis of the large bowel can be performed safely in case of emergency whenever patient comorbidities and local conditions do not stand as major restrictions.

[Laparoscopic cholecystectomy in an overnight admission]. / Internarea de o zi în colecistectomia laparoscopica.

OBJECTIVE: to determine the feasibility and desirability of laparoscopic cholecystectomy (LC) in an overnight versus a several day admission. BACKGROUND: Although LC is performed in U.S.A. as outpatient surgery this has not been generally accepted in Europe. The main objections, are the risk of complications becoming apparent at home. Considering the specific local conditions and the general attitude towards early discharge we tried to assess the degree of feasibility and acceptance of a overnight admission in our patients. METHODS: Two groups of forty patients each, with symptomatic gallstones, received LC either in an overnight or a several day admission. Preoperative and intraoperative data and postoperative recovery were prospectively assessed. RESULTS: The general and female age, the duration and frequency of the biliary pain, the duration and the degree of difficulty of the operation and the necessity of the subhepatic drainage were all significant in favour of the group with a shorter stay. No postoperative complications were recorded. CONCLUSIONS: Overnight LC is safe and effective in treating patients requiring LC. The option of the patient must also be considered.

Right renal artery occlusion as a complication of fibromuscular dysplasia.

Renovascular hypertension is defined as elevated blood pressure levels due to the stenosis/ occlusion of the renal artery caused by fibromuscular dysplasia or atherosclerosis. We present the case of a 59-year old female patient with recently diagnosed arterial hypertension due to renal artery occlusion through intimal fibromuscular dysplasia. In this case, arterial blood pressure levels have not been controlled by maximum doses of antihypertensive drugs, used in association; rapid deterioration of the renal function, as well as important kidney damage, proven by imaging explorations, motivated the laparoscopic nephrectomy.