APPLICATION OF INTESTINAL AUTOTRANSPLANTATION IN TREATMENT OF SURGICAL DISEASES OF THE ABDOMINAL CAVITY

This review is devoted to the relevance of the problem and the assessment of potential surgical indications, surgical methods and clinical results in the intestinal autotransplantation. Radical resection of theneoplasmisperformed. Currently, the main indications for performing intestinal autotransplantation are considered neoplasms of the pancreas, mesenteric and retroperitoneal space with the involvement of the superior mesenteric vessels in the process. Preliminary results demonstrate that radical resection can be effective in carefully selected patients. Although perioperative morbidity and mortality are relatively high, the literature describes some cases with long patient survival, especially when performing radical resection of a benign tumor or a tumor of potentiallow malignant. However, early tumor recurrence remains a serious problem in patients with a high-grade tumor, especially with pancreatic ductal adenocarcinoma (PDAC). It should be noted that when using intestinal autotransplantation, it is possible to perform a radical resection of the organ in patients with separate neoplasms in the abdominal cavity and the involvement of the main mesenteric vessels in the process. However, this aggressive method is associated with significant operational risk and should be only performed in specialized centers. The additional combination therapies have to be developed to optimize the clinical outcome and prolong the survival of patients with pancreatic cancer.

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MANAGEMENT OF POSTOPERATIVE PERITONITIS IN LOW-RESOURCES SERVICES

EUREKA Health Sciences ◽

10.21303/2504-5679.2019.00911 ◽

2019 ◽

Vol 3 ◽

pp. 3-9

Author(s):

Mykola Droniak

Keyword(s):

Mortality Rate ◽

Abdominal Cavity ◽

Postoperative Mortality ◽

Abdominal Sepsis ◽

Postoperative Peritonitis ◽

Drain Tube ◽

Invasive Approach ◽

Surgical Methods ◽

General Complication ◽

Mesenteric Vessels

Background. Postoperative peritonitis (PP) reminds one of the most difficult complications in abdominal surgery with mortality rate 22.3 – 90 %. Methods. In Ivano-Frankivsk Regional (tertiary level) Clinical Hospital (Ivano-Frankivsk, Ukraine) during 2010–2017 were operated 8762 patients with acute and chronic diseases of digestive system (appendicitis, pancreatitis, cholecystitis, bowel obstruction, complicated ulcer of upper gastrointestinal truck, mesenteric vessels thrombosis, abdominal adhesion diseases, hernia, Chron’s diseases, abdominal trauma), among them in 209 (2.4 %) patients developed PP. Local PP (abscess of abdominal cavity) had 142 (67.9 %), diffuse PP – 67 (42.1 %) patients. Results. Clear local symptoms of peritonitis were absent in 178 (85.1 %) of 209 patients. General complication, such as acute respiratory failure had 95 (45.5 %), cardiovascular insufficiency – 68 (32.5 %), hepato-renal dysfunction - 46 (22 %) patients with PP. 129 (61.7 %) patients were treated by minimally invasive approach: 24 patients had laparoscopic lavage with drain of abdominal cavity abscess and 105 - ultrasound guided drain of abscess with catheter. 80 (38.3 %) patients had re-laparotomy (RL): 61 (91 %) from 67 with diffuse PP, 19 (13.4 %) from 142 patients – with local PP. 46 (57.5 %) patients underwent one RL, 26 (32.5 %) – two, 8 (10 %) patients – three RL. With increasing numbers of RL, increase mortality rate: after first RL died 7 (15.2 %) of 46 patients, after second RL – 12 (63.2 %) of 19, after third RL 6 (75 %) of 8 patients. Conclusions. Together with standard surgical methods and precise technique were used lavage of abdominal cavity with 8 – 12 litres of antiseptic solutions, solution for peritoneal dialysis intraabdominally, nasointestinal drain tube, what was favourable for faster treatment of abdominal sepsis, reducing number of RL and postoperative mortality.

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Evaluation of mid-term results of bipolar transurethral resection in the treatment of benign prostatic hyperplasia

World Ecology Journal ◽

10.25726/nm.2019.77.26.001 ◽

2018 ◽

pp. 1-9

Author(s):

А.С. Векильян

Keyword(s):

Surgical Treatment ◽

Benign Prostatic Hyperplasia ◽

Blood Loss ◽

Endoscopic Surgery ◽

Transurethral Resection ◽

Operating Time ◽

Clinical Results ◽

Massive Bleeding ◽

Prostatic Hyperplasia ◽

Surgical Methods

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.

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Comparison of Short-Term Clinical Results and Radiologic Changes Between Two Different Minimally Invasive Decompressive Surgical Methods for Lumbar Canal Stenosis

Spine ◽

10.1097/brs.0000000000004052 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Sunao Tanaka ◽

Kanichiro Wada ◽

Gentaro Kumagai ◽

Toru Asari ◽

Shuichi Aburakawa ◽

...

Keyword(s):

Minimally Invasive ◽

Clinical Results ◽

Short Term ◽

Lumbar Canal Stenosis ◽

Canal Stenosis ◽

Surgical Methods

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Development of a Biomarker-Based Scoring System Predicting Early Recurrence of Resectable Pancreatic Duct Adenocarcinoma

Annals of Surgical Oncology ◽

10.1245/s10434-021-10866-6 ◽

2021 ◽

Author(s):

Keinosuke Ishido ◽

Norihisa Kimura ◽

Taiichi Wakiya ◽

Hayato Nagase ◽

Yutaro Hara ◽

...

Keyword(s):

Scoring System ◽

Radical Resection ◽

Postoperative Recurrence ◽

Early Recurrence ◽

University Hospital ◽

Ductal Adenocarcinoma ◽

Tumor Diameter ◽

Roc Curve Analysis ◽

R1 Resection ◽

Preoperative Serum

Abstract Background Resectable pancreatic ductal adenocarcinoma (R-PDAC) often recurs early after radical resection, which is associated with poor prognosis. Predicting early recurrence preoperatively is useful for determining the optimal treatment. Patients and methods One hundred and seventy-eight patients diagnosed with R-PDAC on computed tomography (CT) imaging and undergoing radical resection at Hirosaki University Hospital from 2005 to 2019 were retrospectively analyzed. Patients with recurrence within 6 months after resection formed the early recurrence (ER) group, while other patients constituted the non-early recurrence (non-ER) group. Early recurrence prediction score (ERP score) was developed using preoperative parameters. Results ER was observed in 45 patients (25.3%). The ER group had significantly higher preoperative CA19-9 (p = 0.03), serum SPan-1 (p = 0.006), and CT tumor diameter (p = 0.01) compared with the non-ER group. The receiver operating characteristic (ROC) curve analysis identified cutoff values for CA19-9 (133 U/mL), SPan-1 (78.2 U/mL), and preoperative tumor diameter (23 mm). When the parameter exceeded the cutoff level, 1 point was given, and the total score of the three factors was defined as the ERP score. The group with an ERP score of 3 had postoperative recurrence-free survival (RFS) of 5.5 months (95% CI 3.02–7.98). Multivariate analysis for ER-related perioperative and surgical factors identified ERP score of 3 [odds ratio (OR) 4.63 (95% CI 1.82–11.78), p = 0.0013] and R1 resection [OR 3.20 (95% CI 1.01–10.17), p = 0.049] as independent predictors of ER. Conclusions For R-PDAC, ER could be predicted by the scoring system using preoperative serum CA19-9 and SPan-1 levels and CT tumor diameter, which may have great significance in identifying patients with poor prognoses and avoiding unnecessary surgery.

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Survival after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Medical Science And Education Of Ural ◽

10.36361/1814-8999-2020-21-4-127-130 ◽

2020 ◽

Vol 21 (4) ◽

pp. 127-130

Author(s):

V. U. Rayn ◽

◽

A. A. Chernov ◽

S. O. Zabotkin ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Pancreatic Ductal Adenocarcinoma ◽

Soft Tissues ◽

Abdominal Cavity ◽

Survival Rates ◽

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

En Bloc ◽

Free Survival ◽

Pancreatic Head Cancer

Aim. To access overall and event-free survival rates in patients after surgical treatment of localized and locally spread pancreatic head cancer. Materials and methods. A single center observational trial was conducted at a low-volume pancreatic surgery center in Khanty-Mansiysk. Data were collected retrospectively from 2007 to 2019. Patients with resectable tumors were included into the study whose final histology showed pancreatic ductal adenocarcinoma and en-bloc resection. According to the technical facilities and actual clinical protocols all patients received surgical treatment only and were then monitored. Data on progression patterns and survival rates were collected and calculated using Kaplan-Meier survival analysis. Results. Median overall survival (OS) after R0 pancreaticoduodenectomy was 16,8 months (IQR 10,9-23,5). Median progression-free survival was 10,6 mo. (IQR 8,0-20,7). OS in jaundiced patients was 4,9 mo. shorter than in patients without jaundice at the diagnosis (р = 0,011). Patients with serum bilirubin level < 100 μmol/l lived on average 7.2 months longer (p = 0.014). Most frequent sites of primary progression were liver and peritoneum, lungs, bones, lymph nodes of the abdominal cavity / retroperitoneal space, less often metastases were found in the skin and soft tissues. In 21.4% of cases metastases were found in several organs simultaneously with most frequent combination of liver and peritoneum, liver and lungs, lungs and bones. The median survival after progression was 7.1 ± 4.8 months Conclusion. Pancreatic duct adenocarcinoma has a high potential for progression and has therefore poor prognosis. To improve long-term outcomes, it is advisable to apply additional therapeutic options perioperatively.

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To the casuistry of strangulated hernias of Douglas space

Kazan medical journal ◽

10.17816/kazmj72216 ◽

1937 ◽

Vol 33 (4) ◽

pp. 490-491

Author(s):

M. V. Dunier

Keyword(s):

Internal Hernia ◽

Abdominal Cavity ◽

Surgical Methods ◽

Methods Of Treatment

The question of an internal hernia of the abdominal cavity is still little developed both from the anatomical and from the clinical side; as well as little developed surgical methods of treatment of these hernias.

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Clinical Characteristics and Overall Survival in Patients with Anaplastic Pancreatic Cancer

The American Surgeon ◽

10.1177/000313481408000218 ◽

2014 ◽

Vol 80 (2) ◽

pp. 117-123 ◽

Cited By ~ 3

Author(s):

Clancy J. Clark ◽

Janani S. Arun ◽

Rondell P. Graham ◽

Lizhi Zhang ◽

Michael Farnell ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Pancreatic Ductal Adenocarcinoma ◽

Tumor Stage ◽

Ductal Adenocarcinoma ◽

Rank Test ◽

Poor Overall Survival ◽

Perioperative Morbidity ◽

Log Rank Test ◽

Kaplan Meier

Anaplastic pancreatic cancer (APC) is a rare undifferentiated variant of pancreatic ductal adenocarcinoma with poor overall survival (OS). The aim of this study was to evaluate the clinical outcomes of APC compared with differentiated pancreatic ductal adenocarcinoma. We conducted a retrospective review of all patients treated at the Mayo Clinic with pathologically confirmed APC from 1987 to 2011. After matching with control subjects with pancreatic ductal adenocarcinoma, OS was evaluated using Kaplan-Meier estimates and log-rank test. Sixteen patients were identified with APC (56.3% male, median age 57 years). Ten patients underwent exploration of whom eight underwent pancreatectomy. Perioperative morbidity was 60 per cent with no mortality. The median OS was 12.8 months. However, patients with APC who underwent resection had longer OS compared with those who were not resected, 34.1 versus 3.3 months ( P = 0.001). After matching age, sex, tumor stage, and year of operation, the median OS was similar between patients with APC and those with ductal adenocarcinoma treated with pancreatic resection, 44.1 versus 39.9 months, ( P = 0.763). Overall survival for APC is poor; however, when resected, survival is similar to differentiated pancreatic ductal adenocarcinoma.

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Treatment of peritoneal surface malignancies with hyperthermic intraperitoneal chemotherapy—current perspectives

Current Oncology ◽

10.3747/co.23.2831 ◽

2016 ◽

Vol 23 (3) ◽

pp. 266 ◽

Cited By ~ 30

Author(s):

J. Spiliotis ◽

E. Halkia ◽

E. De Bree

Keyword(s):

Intraperitoneal Chemotherapy ◽

Hyperthermic Intraperitoneal Chemotherapy ◽

Abdominal Cavity ◽

Gastrointestinal Surgery ◽

Morbidity And Mortality ◽

Peritoneal Surface Malignancy ◽

Perioperative Morbidity ◽

Cancer Management ◽

Peritoneal Surface ◽

Crs And Hipec

Peritoneal carcinomatosis (PTC) represents advanced malignant disease and has generally been associated with a grim prognosis. Peritoneal surface malignancy is often the major source of morbidity and mortality; it is of major concern in cancer management. Although PTC is categorized as metastatic disease, it represents a special disease pattern considered to be a locoregional disease limited to the abdominal cavity. The combination of cytoreductive surgery (CRS) and intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) has successfully been used as locoregional treatment for selected patients with PTC from gastric, colorectal, and ovarian cancer; with mesothelioma; and with pseudomyxoma peritonei. In the prophylactic setting, HIPEC can also be used to prevent PTC in high-risk patients, and the first results of the “second-look” approach are promising. Patient selection—in which the risks of perioperative morbidity and mortality, which are analogous to those for any other major gastrointestinal surgery, are assessed—is of utmost importance. Those risks have to be weighed against the anticipated survival benefit, which depends mainly on tumour biology, extent of disease, and probability of achieving complete CRS. The present review discusses the principles of CRS and HIPEC, the most significant recent clinical data, and current perspectives concerning the application of this treatment modality in various malignancies. Ongoing trials and future directions are noted. It appears that the combination of CRS and HIPEC is an indispensable tool in the oncologist’s armamentarium.

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Correcting Reflux Laparoscopically

Canadian Journal of Gastroenterology ◽

10.1155/1998/274016 ◽

1998 ◽

Vol 12 (5) ◽

pp. 327-332 ◽

Cited By ~ 1

Author(s):

Eric C Poulin ◽

Christopher M Schlachta ◽

Joseph Mamazza

Keyword(s):

Minimally Invasive ◽

Antireflux Surgery ◽

Abdominal Cavity ◽

Learning Curves ◽

Barium Swallow ◽

Short Esophagus ◽

Minimally Invasive Techniques ◽

Laparoscopic Procedures ◽

Surgical Methods ◽

Invasive Techniques

Most operations in the abdominal cavity and chest can be performed using minimally invasive techniques. As yet it has not been determined which laparoscopic procedures are preferable to the same operations done through conventional laparotomy. However, most surgeons who have completed the learning curves of these procedures believe that most minimally invasive techniques will be scientifically recognized soon. The evolution, validation and justification of advanced laparoscopic surgical methods seem inevitable. Most believe that the trend towards procedures that minimize or eliminate the trauma of surgery while adhering to accepted surgical principles is irreversible. The functional results of laparoscopic antireflux surgery in the seven years since its inception have been virtually identical to the success curves generated with open fundoplication in past years. Furthermore, overall patient outcomes with laparoscopic procedures have been superior to outcomes with the traditional approach. Success is determined by patient selection and operative technique. Patient evaluation should include esophagogastroduodenoscopy, barium swallow, 24 h pH study and esophageal motility study. Gastric emptying also should be evaluated. Patients who have abnormal propulsion in the esophagus should not receive a complete fundoplication (Nissen) because it adds a factor of obstruction. Dor or Toupet procedures are adequate alternatives. Prokinetic agents, dilation or pyloroplasty are used for pyloric obstruction ranging from little to more severe. Correcting reflux laparoscopically is more difficult in patients with obesity, peptic strictures, paraesophageal hernias, short esophagus, or a history of previous upper abdominal or antireflux surgery.

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