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1.
Surg Endosc ; 36(1): 607-613, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512630

RESUMO

BACKGROUND: Recent studies have reported the feasibility of indocyanine green fluorescence imaging of adrenal tumors to guide dissection. Although the adrenal has been reported to concentrate the dye more than surrounding tissues, the amount of tissue distinction and how this compares with conventional vision has not been quantified before. The aim of this study is to quantify this distinction using color analysis. METHODS: This was an institutional review board-approved retrospective study. By excluding adrenal cortical carcinoma, metastasis and pheochromocytoma, video recordings of 50 patients who underwent robotic transabdominal lateral adrenalectomy with indocyanine green (ICG) imaging for adrenocortical tumors between August 2015 and May 2018 were reviewed. Using a color analysis software, the pixel intensity of adrenal tumors versus adjacent retroperitoneal tissues was calculated for conventional red, green and blue, as well as indocyanine green (ICG) scales. Statistical analysis was performed using ANOVA. RESULTS: A total of 50 patients underwent unilateral robotic transabdominal lateral adrenalectomy. All procedures were completed robotically without a conversion to laparoscopy or open. Morbidity was 4%. Measured pixel intensity of adrenal tumors was higher than adjacent retroperitoneal tissues for all conventional color and ICG modes (p < 0.0001), with the gradient being more pronounced for ICG green versus conventional red, green and blue modes. CONCLUSIONS: To our knowledge this is the first study attempting to encode tissue planes in robotic adrenalectomy. The results show that the visual contrast distinction observed between adrenal and adjacent retroperitoneal tissues can be quantified using pixel intensity. ICG enabled the distinction of tissue planes with a wider gradient compared to conventional RGB view, quantifying its subjective benefits reported in prior studies.


Assuntos
Neoplasias das Glândulas Suprarrenais , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Humanos , Verde de Indocianina , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos
2.
Surg Endosc ; 36(7): 4939-4945, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34734301

RESUMO

BACKGROUND: The aim of this study was to assess the utility of laparoscopic ultrasound (LUS) during minimally invasive liver procedures in patients with malignant liver tumors who underwent preoperative magnetic resonance imaging (MRI). METHODS: Medical records of patients with malignant liver lesions who underwent laparoscopic liver surgery between October 2005 and January 2018 and who underwent an MRI examination at our institution within a month before surgery were collected from a prospectively maintained database. The size and location of tumors detected on LUS, as well as whether they were seen on preoperative imaging, were recorded. Univariate and multivariate regression analyses were performed to identify factors that were associated with the detection of liver lesions on LUS that were not seen on preoperative MRI. RESULTS: A total of 467 lesions were identified in 147 patients. Tumor types included colorectal cancer metastasis (n = 53), hepatocellular cancer (n = 38), neuroendocrine metastasis (n = 23), and others (n = 33). Procedures included ablation (67%), resection (23%), combined resection and ablation (6%), and diagnostic laparoscopy with biopsy (4%). LUS identified 39 additional lesions (8.4%) that were not seen on preoperative MRI in 14 patients (10%). These were colorectal cancer (n = 20, 51%), neuroendocrine (n = 11, 28%) and other metastases (n = 8, 21%). These additional findings on LUS changed the treatment plan in 13 patients (8.8%). Factors predicting tumor detection on LUS but not on MRI included obesity (p = 0.02), previous exposure to chemotherapy (p < 0.001), and lesion size < 1 cm (p < 0.001). CONCLUSION: This study demonstrates that, despite advances in MRI, LUS performed during minimally invasive liver procedures may detect additional tumors in 10% of patients with liver malignancies, with the highest yield seen in obese patients with previous exposure to chemotherapy. These results support the routine use of LUS by hepatic surgeons.


Assuntos
Carcinoma Hepatocelular , Neoplasias Colorretais , Laparoscopia , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Humanos , Laparoscopia/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/cirurgia , Imageamento por Ressonância Magnética
3.
J Surg Oncol ; 122(5): 973-979, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32602151

RESUMO

BACKGROUND: Compared with conventional thyroidectomy, hypocalcemia rate was reported to be lower after total thyroidectomy (TT) utilizing near infrared fluorescence imaging (NIFI). The aim of this study is to evaluate the impact of NIFI on postoperative parathyroid function after TT. METHODS: This was a retrospective institutional review board-approved study comparing 100 patients who underwent TT with NIFI guidance and 200 patients without, by the same surgeon. Clinical parameters were compared using χ2 and t test. RESULTS: Average number of parathyroid glands identified intraoperatively was similar between two groups. However, rate of incidental parathyroidectomy was higher in conventional (14%) versus NIFI group (6%) (P = .039), despite similar (4% vs 6%, respectively) autotransplantation rates (P = .562). Incidences of transient (6.5% vs 5.0%) and permanent (0.5% vs 0%) hypocalcemia were not statistically different between conventional and NIFI groups (P = NS). CONCLUSION: The use of NIFI during thyroidectomy may decrease the rate of incidental parathyroidectomy by increasing the ability of the surgeon to recognize parathyroid glands with fluorescent contrast distinction. Nevertheless, in contrary to recent reports in literature, postoperative hypocalcemia rate was not altered compared with conventional technique, suggesting that preservation of parathyroid vasculature, rather than an augmented ability to detect the glands, may dominantly affect postoperative function.


Assuntos
Bócio/cirurgia , Doença de Graves/cirurgia , Glândulas Paratireoides/diagnóstico por imagem , Glândulas Paratireoides/fisiologia , Neoplasias da Glândula Tireoide/cirurgia , Cálcio/sangue , Feminino , Bócio/sangue , Bócio/diagnóstico por imagem , Doença de Graves/sangue , Doença de Graves/diagnóstico por imagem , Humanos , Hipocalcemia/etiologia , Masculino , Pessoa de Meia-Idade , Imagem Óptica/métodos , Paratireoidectomia/efeitos adversos , Paratireoidectomia/métodos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos
4.
Surg Endosc ; 34(1): 249-256, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-30945061

RESUMO

BACKGROUND: Since neuroendocrine tumors have an indolent behavior, studies looking at oncologic outcomes should report a long-term follow-up. Over the years, we have been treating selected patients with neuroendocrine liver metastases (NELM) with laparoscopic ablation (LA) and reported favorable local tumor control. The aim of this study is to see whether this local efficacy translates into long-term oncologic outcomes. METHODS: This was an IRB-approved study of patients who underwent LA for NELM at a single center. Overall and progression-free survivals were analyzed using Kaplan-Meier and Cox proportional hazards model. RESULTS: Study included 58 women and 71 men with a median age of 58 (IQR 47-67) years. Tumor type included carcinoid (n = 92), pancreatic islet cell (n = 28), and medullary thyroid cancer (n = 9). There was a median of 6 (IQR 3-8) tumors, measuring 1.6 (IQR 1.1-2.4) cm. At a median follow-up of 73 (IQR 34-135) months, local liver recurrence per patient, new liver recurrence, and new extrahepatic recurrence rates were 22, 68, and 33%, respectively. Local tumor recurrence per lesion was 5% (n = 42/770). Median overall survival was 125 months, with 5-year, and 10-year overall survivals being, 76%, and 59%, respectively; and median disease-free survival was 13 months, with 5-year, and 10-year progression-free survivals being 26%, and 6%, respectively. On Cox proportional hazards model, overall survival was independently predicted by tumor size, grade, and resection status of primary. CONCLUSION: To our knowledge, this is the largest single-center experience with the longest follow-up regarding the utilization of LA for NELM. Our results demonstrate that in selected patients, LA achieves a 95% local tumor control and 59% 10-year overall survival.


Assuntos
Técnicas de Ablação/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Tumores Neuroendócrinos/secundário , Tumores Neuroendócrinos/cirurgia , Adulto , Idoso , Neoplasias Brônquicas/patologia , Feminino , Seguimentos , Neoplasias Gastrointestinais/patologia , Humanos , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Tumores Neuroendócrinos/mortalidade , Neoplasias Pancreáticas/patologia , Estudos Retrospectivos , Análise de Sobrevida , Neoplasias da Glândula Tireoide/patologia , Resultado do Tratamento
5.
Surg Endosc ; 34(2): 536-543, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30963261

RESUMO

BACKGROUND: Laparoscopic liver resection (LLR) of posterosuperior (PS) segment liver tumors is technically challenging with confusion about optimal patient positioning and trocar placement (i.e., transabdominal vs. transcostal). The aim of this study is to describe our technique and outcomes with LLR of these tumors. METHODS: This is an IRB-approved retrospective review of a prospective database. Between 2005 and 2017, patients with benign and malignant lesions underwent LLR. Perioperative outcomes of PS (segments 4A, 7, and 8) and anterolateral (AL) resections were compared. All patients were operated through intra-abdominal trocars in the supine position. RESULTS: 304 patients underwent LLR for AL (n = 217) and PS (n = 87) segmental lesions. Minor liver resections were performed in 274 patients and major resections in 30. Groups were comparable for age, sex, pathology, and tumor size (mean 4.2 and 3.7 cm for AL and PS). Inflow occlusion was more frequently performed for PS resections, but precoagulation rates were similar. PS resections more frequently required hand assistance (50% vs. 20%, p < 0.001) and conversion to open (18% vs. 7%, p = 0.04). For PS versus AL resections, operative time (253 vs. 205 min, p ≤ 0.001) was longer and associated with more blood loss (307 vs. 211 mL, p < 0.001) and more frequent need for blood transfusion (15% vs. 7%, p = 0.04). However, the rate of negative resection margin, 90-day complication rates, and length of stay were similar between the two groups. CONCLUSION: This study shows that LLR of PS located liver tumors is more challenging compared to AL lesions. Nevertheless, it can be performed successfully in the majority of patients with supine positioning and intra-abdominal trocar placement, without compromising oncologic principles. Liberal uses of hand assistance and inflow occlusion were the technical tips helping us to successfully resect these tumors laparoscopically.


Assuntos
Hepatectomia/instrumentação , Laparoscopia/instrumentação , Neoplasias Hepáticas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Instrumentos Cirúrgicos , Adulto , Idoso , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia/métodos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Posicionamento do Paciente , Estudos Retrospectivos , Decúbito Dorsal
6.
Surg Innov ; 27(5): 445-454, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32242764

RESUMO

Background. Laparoscopic cholecystectomy (LC) often results in postoperative pain, especially in the abdomen. Intraperitoneal local anesthesia (IPLA) reduces pain after LC. Acute cholecystitis-associated inflammation, increased gallbladder wall thickness, dissection difficulties, and a longer operative time are several reasons for assuming a benefit in pain scores in urgent LC with IPLA application. The aim was to determine the postoperative analgesic efficacy of high-volume, low-dose intraperitoneal bupivacaine in urgent LC. Materials and Methods. Fifty-seven patients who were American Society of Anesthesiologists physical status I or II were randomly assigned to receive either normal saline (control group) or intraperitoneal bupivacaine (test group) at the beginning or end of urgent LC. The primary outcome was the postoperative pain score of the Visual Analogue Scale (VAS). The secondary outcomes included Visual Rating Prince Henry Scale (VRS), patient satisfaction, and analgesic consumption. Results. Postoperative VAS scores at the first and fourth hours were significantly lower in the test group than in the control group (P < .001). Postoperative VRS scores at the first, fourth, and eighth hours were significantly lower in the test group than in the control group (P < .001, P = .002, P = .004, respectively). Analgesic use was significantly higher in the control group at the first postoperative hour (P < .001). Shoulder pain was significantly lower, and patient satisfaction was significantly higher in the test group relative to the control group (both P < .001). Conclusion. High-volume, low-concentration intraperitoneal bupivacaine resulted in better postoperative pain control and reduced incidence of shoulder pain and analgesic consumption in urgent LC.


Assuntos
Bupivacaína , Colecistectomia Laparoscópica , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Colecistectomia Laparoscópica/efeitos adversos , Humanos , Injeções Intraperitoneais , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos
7.
HPB (Oxford) ; 22(5): 764-769, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31653594

RESUMO

BACKGROUND: Indocyanine green (ICG) fluorescence imaging (ICG-FI) has been suggested for intraoperative identification of liver tumors. We aim to compare the intraoperative diagnostic utility of this imaging modality with laparoscopic ultrasound (LUS). METHODS: This is an IRB-approved prospective study. ICG was administered intravenously 1-2 days before surgery. The findings on ICG-FI were compared to those on preoperative cross-sectional imaging (POCSI), LUS, diagnostic laparoscopy (DL). RESULTS: A total of 144 lesions (62 superficial [visible on DL] and 82 deep) were detected in the study patients. POCSI identified 74%, LUS identified 92%, and ICG-FI identified 43%. ICG-FI detection rate was higher for superficial (95%) versus deep lesions (4%). 3% (4/144) of all lesions were seen only on ICG-FI. However, all of these lesions were small and superficial lesions that were apparent on DL. CONCLUSION: Although ICG-FI allowed detection of small superficial lesions that were not identifiable by POCSI or LUS, these lesions were apparent on DL even before ICG-FI. Therefore, its utility as an intraoperative diagnostic modality is limited at the dosage and timing used in the study. We believe that rather than a diagnostic tool, it has more potential for a dynamic use in guiding the resection of superficial lesions and delineating segmental/lobar anatomy.


Assuntos
Laparoscopia , Neoplasias Hepáticas , Humanos , Verde de Indocianina , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Imagem Óptica , Estudos Prospectivos
8.
Surg Laparosc Endosc Percutan Tech ; 34(1): 69-73, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38063573

RESUMO

BACKGROUND: Despite advancements in technology and expertise, ERCP carries risks of significant complications, such as pancreatitis, bleeding, and perforation. Post-ERCP pancreatitis is the most common and important complication following ERCP. In our study, we aimed to examine the relationship between patient and procedure-related parameters and the development of pancreatitis. METHODS: Four hundred patients who underwent ERCP between January 1, 2019 and December 31, 2020, at the General Surgery Clinic of the Bakirköy Dr. Sadi Konuk Health Application and Research Center of the University of Health Sciences Faculty of Medicine were retrospectively evaluated. Patient and procedure-related factors were analyzed statistically through univariate and multivariate analyses. RESULTS: Age, urgent indication, ERCP history, cholangitis, precut sphincterotomy, common bile duct diameter, pancreatic cannulation, pancreatic stent, and bleeding were statistically significant risk factors for post-ERCP pancreatitis (+). In multivariate analysis, the effects of urgent indication, ERCP history, cholangitis, precut sphincterotomy, common bile duct diameter, and pancreatic cannulation on post-ERCP pancreatitis were statistically significant risk factors ( P <0.05). DISCUSSION: This study demonstrates that emergency indication, ERCP history, cholangitis, precut sphincterotomy, and pancreatic cannulation are significant risk factors for the development of post- ERCP pancreatitis. One notable contribution of our study to the existing literature is the unique analysis of post-sphincterotomy bleeding as an independent factor.


Assuntos
Colangite , Pancreatite , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Estudos Retrospectivos , Pancreatite/epidemiologia , Pancreatite/etiologia , Fatores de Risco , Esfinterotomia Endoscópica/efeitos adversos , Colangite/complicações
9.
Ir J Med Sci ; 2024 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-39230650

RESUMO

PURPOSE: Appendectomy is the standard treatment of acute appendicitis. However, recent advancements have introduced medical treatment as a potential alternative. Within this context, it's important to recognize the rare occurrence of appendiceal tumors, often incidentally discovered during histopathological examination following appendectomy. Consequently, there's a concern about the possibility of overlooking appendiceal neoplasms, particularly in cases where conservative treatment for acute appendicitis is considered. METHODS: The files of patients who underwent surgery for acute appendicitis between January 2015 and December 2023 and were diagnosed with neoplasia in their pathology reports were retrospectively registered. Demographic characteristics of the patients, laboratory and imaging features, details of the surgery performed, preoperative and intraoperative suspicion of neoplasm and data from pathology reports were collected and analyzed. RESULTS: A total of 6446 patients were operated for acute appendicitis. Neoplasia was detected in the histopathological examination of 93 patients (1.44%). Acute appendicitis was diagnosed in 51.6% of the patients by computed tomography. Neoplasm suspicion was present in 9.7% of patients in preoperative imaging methods and in 6.5% of patients intraoperatively. Only appendectomy was performed in 94.5% of patients. The most common appendiceal neoplasm is neuroendocrine tumors (40.9%), followed by appendiceal mucinous neoplasm (29%), sessile serrated adenoma (15%), and adenocarcinoma (6.5%). CONCLUSION: Although appendiceal neoplasms are relatively rare in proportion, they represent a significant numerical value due to the density of cases. Therefore, this information should be taken into consideration when evaluating treatment options for acute appendicitis.

10.
Sisli Etfal Hastan Tip Bul ; 57(3): 305-311, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37900343

RESUMO

Objectives: Although thyroidectomy is completed with a cervical incision in most patients with substernal goiter (SG), sternotomies may be required occasionally. The purpose of this study is to examine computed tomography (CT) findings that may predict the need for sternotomy in SG surgery. Methods: Neck-thoracic CT images of patients who underwent total thyroidectomy with the diagnosis of SG between 2013 and 2022 were retrospectively examined. The patients (n=41) were divided into two groups: sternotomies (n=6) and cervical (n=35). Preoperative pathological data, CT findings, and postoperative complications of the patients were recorded. Results: The total thyroid volume of the sternotomy group (280.75±127.01 mm3) was significantly greater than that of the cervical group (155.38±74.18 mm3) (p=0.015). The retrosternal thyroid volume (mm3), thyroid craniocaudal, and anterior-posterior dimensions (mm) were significantly greater in the sternotomy group (p=0.001, p<0.001, and p=0.004, respectively). While the majority of mediastinal extension degrees in the cervical group were grade 1 (80%), grade 2 (83%) predominated in the sternotomy group (p=0.001). Conclusion: The radiological findings of total thyroid volume, retrosternal thyroid tissue volume, retrosternal thyroid length, thyroid anterior-posterior dimension, and mediastinal extension degree on CT are valuable in predicting the decision to perform a sternotomy in SG surgery.

11.
Ann Endocrinol (Paris) ; 84(1): 8-13, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36252847

RESUMO

PURPOSE: Forearm osteoporosis is a well-known complication of primary hyperparathyroidism (PHPT). However, measuring forearm bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) at the distal radius is often neglected in clinical practice despite the fact that osteoporosis at any site is a criterion indicating surgery. We aimed to evaluate the importance and priority of forearm BMD and to determine its association with biochemical parameters. MATERIAL AND METHODS: Three hundred fourteen patients (272 females, 42 males) with PHPT who had BMD measurements at 3 sites were recruited for this retrospective study. The effect on surgical indications of osteoporosis only in the forearm was evaluated. Group 1 (n=151) with forearm osteoporosis and group 2 (n=163) without were compared in terms of biochemical and clinical parameters. RESULTS: In the overall study population, 165 of the 314 patients had osteoporosis in at least 1 site. Twenty seven percent (n=86/314) had osteoporosis only in the forearm, while the other 2 sites (lumbar spine and femoral neck) were normal or osteopenic. Surgery was indicated based on osteoporosis only in the forearm in 10% of patients (n=30/314). Corrected calcium and parathyroid hormone levels were significantly higher in group 1 than group 2 (p=0.001 and p<0.001, respectively) and were also negatively correlated with distal radius BMD, T-score and Z-score in the whole study group. CONCLUSION: Including the distal radius in BMD measurement increased the number of patients diagnosed with osteoporosis and for whom surgery was indicated. Calcium and PTH were also more frequently elevated in patients with forearm osteoporosis. These results show that distal radius BMD is relevant to the management of PHPT.


Assuntos
Hiperparatireoidismo Primário , Osteoporose , Masculino , Feminino , Humanos , Densidade Óssea , Antebraço , Cálcio , Estudos Retrospectivos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/cirurgia , Hiperparatireoidismo Primário/diagnóstico , Osteoporose/diagnóstico
12.
Ann Ital Chir ; 94: 173-178, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37203297

RESUMO

OBJECTIVES: To evaluate our experience and short term surgical outcomes between two robotic systems. METHODS: The present study retrospectively analyzed 38 cases, who underwent robotic adrenalectomy between 2012-2019 at our center. The patients were divided into Group Si (n=11) and Group Xi (n=27), and the results of these two groups were compared. RESULTS: Demographic characteristics of both groups were similar between two groups. While, 42% of the patients had Cushing syndrome, 22% had Pheochromocytoma and 22% had Conn syndrome in the Xi group, 72% of the patients were non-secreting adrenocortical adenoma in Si group (p=0.005). The mean docking time in Group Xi was shorter than Si group (p=0.027). Console and total operation times were similar in both groups (p=0.312 and p=0.424; respectively). The intraoperative complication rate (p=0.500) and hospital stay (3.2±1.0 vs. 2.52±1.42 days, respectively, p = 0.077) were similar in both groups. Postoperative 4th and 12th hour Visual Analog Scale (VAS) scores were similar (p=0.213 and p=0.857; respectively). The average cost of robotic consumables was $210 higher in Xi group (p=0.495). CONCLUSION: Our study shows that; the Xi robotic system is as safe as the Si system for adrenalectomy operations. KEY WORDS: Adrenal gland surgery, Minimally invasive adrenalectomy, Robotic surgery.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adrenalectomia/métodos , Laparoscopia/métodos
13.
J Coll Physicians Surg Pak ; 32(8): 1070-1072, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35932137

RESUMO

Ingestion of a foreign body is generally observed in the psychiatric patients and children. Healthy adult individuals may also swallow a foreign body unintentionally. Here, we report a case of a patient who swallowed a plastic fork and treated with laparoscopic repair. A 46-year man was admitted to the emergency room with the abdominal pain. His physical evaluation and diagnostic imaging revealed free air in the abdomen. Further imaging with CT scan showed a foreign body in the proximal ileum. On taking details of his swallowing history, he remembered swallowing a broken part of a plastic fork unwittingly during dinner. Following the removal of the foreign body, the perforation area was primarily repaired in double layers. The postoperative course was uneventful. An accurate diagnosis of the small intestinal perforation caused by the ingested foreign bodies, particularly in cases where the patient is unaware of the ingestion, can be difficult. CT scan is a useful tool when available to establish the diagnosis before the surgical intervention. Key Words: Small intestine, Perforation, Foreign body, Laparoscopic surgery.


Assuntos
Corpos Estranhos , Perfuração Intestinal , Dor Abdominal/etiologia , Adulto , Criança , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Íleo/diagnóstico por imagem , Íleo/cirurgia , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Plásticos
14.
Wideochir Inne Tech Maloinwazyjne ; 17(1): 143-149, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35251399

RESUMO

INTRODUCTION: The method of stump closure is controversial in complicated patients, especially with appendix base necrosis or perforation. AIM: To evaluate the efficacy and safety of partial cecum resection technique with an endostapler in patients with appendix base necrosis or perforation. MATERIAL AND METHODS: Thirty-six patients who underwent laparoscopic partial cecum resection due to appendix base necrosis or perforation between 2015 and 2020 were retrospectively analyzed. In acute complicated appendicitis with appendiceal base necrosis or perforation, it was performed by laparoscopic partial cecum resection using an endostapler within a safe surgical margin. Demographic characteristics, duration of operation, days of hospital stay, and intra- and post-operative complications were evaluated. RESULTS: The mean age of the patients is 42.72 ±16.69, female/male ratio was 19/17 (52.8%/47.2%). No intraoperative complications developed. Mean operative time and hospital stay were 104.75 ±34.96, 4.58 ±2.82 days, respectively. Post-operative complications developed in 5 (13.7%) patients. One of them was wound infection (2.7%), 2 of them were ileus (5.5%) and 2 patients had an intraabdominal abscess (5.5%). Stapler line leak was not observed in any of the patients. CONCLUSIONS: The use of an endostapler in laparoscopic appendectomy is a safe and effective technique in cases where appendix base necrosis, appendix perforation or severe inflammation affects the base of the cecum.

15.
Surg Laparosc Endosc Percutan Tech ; 32(3): 373-379, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35583552

RESUMO

BACKGROUND: Conversion is a surgical concern because the surgical technique can change during surgery. Surprisingly, there is no study in the literature on the causes and risk factors leading to conversion in laparoscopic total extraperitoneal inguinal repair (TEP). There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of conversion during TEP. MATERIALS AND METHODS: We recruited 962 consecutive patients who underwent TEP between May 2016 and May 2021. All data were collected retrospectively. The outcomes of patients who converted to open surgery were compared with those without conversion. Multivariate analysis identified independent risk factors for conversion. RESULTS: The overall incidence of conversion was 4.05% (n=39). The median age was 42 years (18 to 83) and body mass index was 25.2 kg/m2 (15.67 to 32.9). Significant clinical factors associated with conversion included old age, American Society of Anesthesiologists (ASA) score, large peritoneal tear (PT), Charlson comorbidity index, previous surgery, large hernial defects, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for conversion: large hernial defect, large PT, previous lower abdominal surgery, previous hernia surgery, and scrotal hernia. CONCLUSION: Conversion is a minor complication seen during TEP and its incidence varies depending on many factors. Previous lower abdominal surgery and a large PT carries a 6-fold increased risk for conversion from laparoscopic to open surgery during TEP.


Assuntos
Hérnia Inguinal , Laparoscopia , Adulto , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
16.
Ann Ital Chir ; 92: 286-293, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36052459

RESUMO

BACKGROUND: Surgical treatment of Graves' disease (GD) has increased risk for bleeding, hypothyroidism and recurrent laryngeal nerve (RLN) palsy compared to other benign thyroidectomy indications. Nevertheless, it can be done safely in high volume centers. In some particular cases (i.e., anti-thyroid drug intolerance or thyrotoxicosis), urgent surgical treatment might be needed. In this study, we aimed to compare the complications of thyroidectomy in urgent and elective management of Graves' disease. METHODS: The patients, who underwent total thyroidectomy due to Graves' disease between 2012-2019 (n=113) were evaluated retrospectively in terms of demographics, pre-operative laboratory results, management, hospital admissions, operative and post-operative short-term outcomes, morbidity and mortality. Patients who were hospitalized to endocrinology department due to uncontrollable hyperthyroidism and related complications and who were prepared for surgery with Lugol's solution, plasmapheresis and steroids were considered as Urgent Group (n=12). Remaining 101 patients who underwent elective surgery considered as Elective Group. Surgical short-term outcomes, morbidity and mortality rates were compared. RESULTS: Of the 113 patients who were operated for GD, 92 were female and 21 were male. In urgently operated group, FT4 and FT3 levels were significantly higher (p<0.001 and p=0.001, respectively). There was no significant difference in transient or permanent hypocalcemia (p=0.821 and p=0.501, respectively), transient or permanent RLN palsy (p=0.356, p=0.634, respectively) and post-operative bleeding (p=0.338), between elective surgery and rapid optimization groups. CONCLUSION: Emergency surgery for Graves' disease can be performed safely with the application of effective pre-operative treatment protocols. KEY WORDS: Graves' Disease, Thyroidectomy complications, Urgent thyroidectomy.


Assuntos
Doença de Graves , Paralisia das Pregas Vocais , Feminino , Doença de Graves/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Resultado do Tratamento , Paralisia das Pregas Vocais/etiologia
17.
J Invest Surg ; 35(1): 119-125, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33138658

RESUMO

BACKGROUND: The COVID-19 pandemic caused by SARS-CoV-2 commenced in Wuhan China in 2019 and soon spread worldwide. SARS-CoV-2 enters the cell by binding to the ACE II receptor and begins viral replication. The effects and clinical findings of SARS-CoV-2 on the liver, kidney, heart, gastrointestinal (GI) system and especially lungs have been widely discussed. However, the effects on the pancreas-another organ that also expresses ACE II-have not been studied. METHODS: This work prospectively evaluated data from 316 patients who were admitted with a diagnosis of COVID-19 pneumonia. The patients were categorized into three according to the severity of pneumonia (mild, severe, critical). Demographic data, rate of pancreatitis, biochemical parameters, and radiological images from each group were analyzed. The patients were divided into two groups and outcomes were compared: COVID-19 patients with acute pancreatitis (Group P) and without acute pancreatitis (Group C). RESULTS: The median age was 54 (18-87), and the median age for patients with acute pancreatitis was 55 (26-84). As an expected finding, we found a positive correlation between advanced age and mortality (p = 0.0003). 12.6% of the patients had acute pancreatitis. While pancreatitis was not seen in patients on mild status, the rate of pancreatitis was 32.5% in critical patients. Hospitalization and mortality rates were higher in patients with COVID-19 accompanied by acute pancreatitis (p = 0.0038 and p < 0.0001, respectively). C-Reactive Protein (CRP) and ferritin were significantly higher in those who had pancreatitis (p < 0.0001). D-Dimer and procalcitonin levels had only a small difference (p = 0.1127 and p = 0.3403, respectively). CONCLUSION: Acute pancreatitis alone is a clinical condition that can lead to mortality and may be one of the reasons for the exaggerated immune response developing in the progression of COVID-19. Our results point out that the presence of pancreatic damage triggered by SARS-CoV-2 can deteriorate the clinical condition of patients and the mortality rate may increase in these patients.


Assuntos
COVID-19 , Pancreatite , Doença Aguda , Humanos , Pessoa de Meia-Idade , Pancreatite/epidemiologia , Pandemias , SARS-CoV-2
18.
Ann Ital Chir ; 92: 183-189, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33576338

RESUMO

INTRODUCTION: Anastomotic leakage (AL) is one of the most disastrous complications after rectosigmoid cancer operations. The aim of this study is to investigate the effect of the insertion time of circular stapler anvil on assessing the blood supply of the proximal colon segment, and thus to evaluate the prevention of early anastomotic leaks. MATERIAL METHODS: A total of 57 patients were included in the study, 25 patients in group A and 32 patients in group B, respectively. From the beginning of the operation to the time of anvil placement in group A, it was 32.08 (± 7.34) minutes, and in group B it was 92.19 (± 16.63) minutes. None of the patients in group A had AL, and 4 patients in group B had AL. DISCUSSION: Our study shows that the anvil must be placed at the beginning of the dissection to evaluate the anomalies that cause anastomotic leaks. We think that this method increases the reliability of the anastomosis line. Thus, the hospitalization period of the patients was shortened and they returned to their active lives faster. In addition, patients used less antibiotics and they needed less medical treatment. KEY WORDS: Anastomotic leaks, Anvil, Rectosigmoid cancer placement, Stapler colorectal.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica , Protectomia/efeitos adversos , Neoplasias Retais/cirurgia , Grampeamento Cirúrgico , Idoso , Fístula Anastomótica/etiologia , Fístula Anastomótica/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Protectomia/instrumentação , Protectomia/métodos , Reto/irrigação sanguínea , Reto/cirurgia , Reprodutibilidade dos Testes , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/instrumentação , Grampeamento Cirúrgico/métodos , Fatores de Tempo
19.
Surg Laparosc Endosc Percutan Tech ; 31(5): 571-577, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33935260

RESUMO

PURPOSE: Laparoscopic total extraperitoneal repair (TEP) is one of the most preferred minimally invasive methods for inguinal hernia repair. In our study, we aimed to compare the advantages and disadvantages of general anesthesia (GA), spinal anesthesia (SA), and epidural anesthesia (EA) for TEP operations. MATERIALS AND METHODS: This is a retrospective study involving 221 patients who underwent TEP surgery for inguinal hernia between January 2018 and July 2020. Patients were divided into 3 groups as GA (n=77), SA (n=70), and EA (n=74). Demographic data of the patients, duration of anesthesia and surgery, perioperative and postoperative complications, postoperative pain, anatomical delineation, hospital stay and quality of life were evaluated. RESULTS: Anesthesia time was the longest in the EA group (23.1±2.32 min) and significantly prolonged the operation time (P<0.001). When the visual analog scale scores were compared, it was observed that the patients in the GA group felt significantly more pain (P<0.001). While the rates of hypotension and headache were higher in regional anesthesia (P<0.001 and P<0.002), there was no significant difference in urinary retention, postoperative nausea/vomiting, and shoulder pain (P=0.274, 0.262, and 0.314, respectively). SA and EA groups were found to be superior compared with the GA group in terms of patient satisfaction (P<0.001). CONCLUSION: Regional anesthesia (SA and EA) can be safely performed in TEP surgeries, gives results similar to the anatomical delineation satisfactory and complication rates of GA, and results in less postoperative pain.


Assuntos
Raquianestesia , Hérnia Inguinal , Laparoscopia , Hérnia Inguinal/cirurgia , Humanos , Qualidade de Vida , Estudos Retrospectivos
20.
Sisli Etfal Hastan Tip Bul ; 55(3): 325-332, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34712073

RESUMO

OBJECTIVE: The aim of this study is to compare the intraoperative and short-term outcomes of different surgical approaches for hormone active and non-functional adrenal masses. METHODS: The data of 206 patients who underwent adrenal gland surgery in our clinic between 2012 and 2020 were retrospectively analyzed. Pre-operative outpatient clinic records of the patients, imaging methods, laboratory results and surgery records, operation time (OT), amount of bleeding, duration of hospital stay, and complications were evaluated. Patients were divided into two groups as those with non-functional mass (n=80) and those with hormoneactive mass (n=126). RESULTS: The median age of the patients was 52 (range 19-83) and 77.2% of them were female. Tumor size was larger in hormone active group (p=0.311), and the difference was more pronounced in the pheochromocytoma subgroup (p=0.088). The rate of transition to open surgery was similar in both groups (0.959), and no conversion to laparoscopy or conventional open surgery was performed in robotic cases. The duration of surgery (p=0.669), mean amount of blood loss (p=0.834), and mean hospital stay (p=0.195) were also similar between the two groups. Intraoperative and post-operative complications were similar between two groups (p=0.573 and p=0.415, respectively). Considering the subgroup analysis of the patients in hormone active group; the duration of hospital stay was longer in patients with Cushing syndrome (p=0.001), while there was no difference in OT and estimated blood loss between patients who were operated for Conn, Cushing, and pheochromocytoma (p=0.086 and p=0.099; respectively). CONCLUSION: Surgical results of hormone active adrenal masses were found to be similar to non-functional masses. Although the hormonal condition of the mass does not change the difficulty level of the surgical procedure, it may be recommended that the robotic approach be preferred to facilitate manipulation in these masses.

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