Laparoscopic approach for inflammatory bowel disease surgical management

For IBD surgical management, laparoscopic approach offers several theoretical advantages over the open approach. However, the frequent presence of adhesions from previous surgery and the high rate of inflammatory lesions have initially questioned its feasibility and safety. In the present review article, we will discuss the role of laparoscopic approach for IBD surgical management, along with its potential benefits as compared to the open approach.

Download Full-text

The Role of Genetics in the Surgical Management of Inflammatory Bowel Disease

Seminars in Colon and Rectal Surgery ◽

10.1053/j.scrs.2012.02.002 ◽

2012 ◽

Vol 23 (2) ◽

pp. 44-50 ◽

Cited By ~ 1

Author(s):

Tara M. Connelly ◽

Walter A. Koltun

Keyword(s):

Inflammatory Bowel Disease ◽

Surgical Management ◽

Bowel Disease ◽

Inflammatory Bowel

Download Full-text

The role of the laparoscopic approach in the surgical management of acute adhesive small bowel obstruction

BMC Surgery ◽

10.1186/s12893-019-0504-x ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 10

Author(s):

Enric Sebastian-Valverde ◽

Ignasi Poves ◽

Estela Membrilla-Fernández ◽

María José Pons-Fragero ◽

Luís Grande

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Surgical Management ◽

Bowel Obstruction ◽

Laparoscopic Approach ◽

Adhesive Small Bowel Obstruction

Download Full-text

THE ROLE OF LAPAROSCOPY IN GYNECOLOGIC EMERGENCIES

Romanian Journal of Clinical Research ◽

10.33695/rjcr.v3i1.44 ◽

2020 ◽

Vol 3 (1) ◽

pp. 3-7

Author(s):

I. Slavu ◽

A. Tulin ◽

D. N. Păduraru ◽

B. Socea ◽

V. Braga ◽

...

Keyword(s):

Hospital Stay ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Abdominal Ultrasound ◽

Consecutive Series ◽

Open Approach ◽

Simultaneous Treatment ◽

Access Path ◽

Therapeutic Opportunity

We performed an analytical, cohort, retrospective study, starting from our own experience, to explore the role of laparoscopy in acute gynecological abdominal emergencies. The present work was obtained at the “Prof. Dr. Agrippa Ionescu” Hospital, Bucharest and includes a consecutive series of 37 patients, admitted in emergency settings, during the past 5 years. In order to complete the diagnosis, all of the patients included in the study were investigated using an abdominal ultrasound. The following aspects were investigated: the correlation between the preoperative diagnosis and the lesions identified by laparoscopy, the rate of postoperative complications, reintervention rate, length of hospital stay, conversion rate. Our results show that the laparoscopic approach has a decreased length of hospital stay, and can offer both a diagnosis opportunity and a therapeutic opportunity with results comparable with that of an open approach. Also, laparoscopy allows simultaneous treatment of other abdominal pathologies using the same access path. Our experience shows that the need for a correct and rapid diagnosis when an acute surgical abdomen is suspected is of paramount importance and laparoscopy can offer this opportunity.

Download Full-text

The Role of Cytokines in Inflammatory Bowel Disease

Mediators of Inflammation ◽

10.1155/s0962935194000013 ◽

1994 ◽

Vol 3 (1) ◽

pp. 3-9 ◽

Cited By ~ 2

Author(s):

G. Radford-Smith ◽

D. P. Jewell

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Intestinal Inflammation ◽

Inflammatory Lesions ◽

Immunoregulatory Cytokines ◽

Current Thinking ◽

Inflammatory Bowel ◽

Chronic Intestinal Inflammation ◽

Th1 And Th2

Cytokines play an important role in the development and persistence of the inflammatory lesions seen in Crohn's disease and ulcerative colitis. This review discusses the current thinking of the role of cytokines in chronic intestinal inflammation including the involvement of immunoregulatory cytokines within the Th1 and Th2 subsets.

Download Full-text

The role of bilateral adrenalectomy in the treatment of refractory Cushing's disease

Neurosurgical FOCUS ◽

10.3171/2014.10.focus14684 ◽

2015 ◽

Vol 38 (2) ◽

pp. E9 ◽

Cited By ~ 13

Author(s):

Anni Wong ◽

Jean Anderson Eloy ◽

James K. Liu

Keyword(s):

Cushing’S Disease ◽

High Risk Patient ◽

Laparoscopic Approach ◽

Bilateral Adrenalectomy ◽

Long Term Results ◽

Cushing's Disease ◽

Open Approach ◽

Effective Treatment Modality

Cushing's syndrome (CS) results from sustained exposure to excessive levels of free glucocorticoids. One of the main causes of CS is excessive adrenocorticotropic hormone (ACTH) secretion by tumors in the pituitary gland (Cushing's disease [CD]). Cushing's disease and its associated hypercortisolism have a breadth of debilitating symptoms associated with an increased mortality rate, warranting urgent treatment. Currently, the first line of treatment for CD is transsphenoidal surgery (TSS), with excellent long-term results. Transsphenoidal resections performed by experienced surgeons have shown remission rates ranging from 70% to 90%. However, some patients do not achieve normalization of their hypercortisolemic state after TSS and continue to have persistent or recurrent CD. For these patients, various therapeutic options after failed TSS include repeat TSS, radiotherapy, medical therapy, and bilateral adrenalectomy (BLA). Bilateral adrenalectomy has been shown to be a safe and effective treatment modality for persistent or recurrent CD with an immediate and definitive cure of the hypercortisolemic state. BLA was traditionally performed through an open approach, but since the advent of laparoscopic adrenalectomy, the laparoscopic approach has become the surgical method of choice. Advances in technology, refinement in surgical skills, competency in adrenopathology, and emphasis on multidisciplinary collaborations have greatly reduced morbidity and mortality associated with adrenalectomy surgery in a high-risk patient population. In this article, the authors review the role of BLA in the treatment of refractory CD. The clinical indications, current surgical and endocrinological results reported in the literature, surgical technique (open vs laparoscopic), drawbacks, and complications of BLA are discussed.

Download Full-text

Surgical Management of Rhabdomyosarcoma of the Nasal Cavity and Paranasal Sinuses: Analysis of Operative Indications, Settings, and Outcomes

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1736590 ◽

2021 ◽

Author(s):

Lulia A. Kana ◽

Joshua D. Smith ◽

Emily L. Bellile ◽

Rashmi Chugh ◽

Erin L. McKean

Keyword(s):

Nasal Cavity ◽

Surgical Management ◽

Nasolacrimal Duct ◽

High Rate ◽

Surgical Approaches ◽

R0 Resection ◽

Study Cohort ◽

Academic Center ◽

Operative Indications

Abstract Objectives The role of surgery in management of sinonasal rhabdomyosarcoma (SNRMS) has traditionally been limited, owing to anatomic and technological challenges and the established role of systemic therapy. Herein, we report our institutional experience with surgical management of SNRMS, with a particular focus on operative approaches, extent and outcomes. Design This study is a retrospective cohort study. Setting This study was conducted at a single-institution, academic center. Participants Patients of any age with histologically confirmed RMS of the nasal cavity, maxillary, ethmoid, frontal, or sphenoid sinus, nasolacrimal duct, or nasopharynx presenting between 1994 and 2020 were included in this study. Main Outcome Measures Demographics, tumor characteristics, operative settings, complications and recurrence, and survival outcomes were the primary outcomes of this study. Results Our study cohort comprised of 29 patients (mean [range] age: 27.0 [3.1–65.7], n = 12 [41%] female). Tumors of the nasal cavity (n = 10, 35%) and ethmoid sinuses (n = 10, 35%) and those with alveolar histology (n = 21, 72%) predominated. Patients who had surgery as part of their treatment (n = 13, 45%) had improved distant metastasis-free survival (DMFS) overall (hazard ratio [HR]: 0.32, 95% CI: 0.11, 0.98, p = 0.05) as compared with those who did not have surgery. Surgical approaches included open (n = 7), endoscopic (n = 4), and combined (n = 2). Eight of these 13 patients (62%) had an R0 resection. Additionally, surgical salvage of recurrent disease was employed in five patients (17%). Conclusion SNRMS is an aggressive malignancy with a high rate of recurrence and spread requiring a multidisciplinary approach for optimal outcomes. Our data supports an expanding role for surgery for SNRMS given its feasibility, tolerability, and potential to improve outcomes.

Download Full-text

Hot Topics in Surgical Management of Acute Diverticulitiss

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld-555 ◽

2020 ◽

Vol 28 ◽

pp. 29-34 ◽

Cited By ~ 1

Author(s):

Gian Andrea Binda ◽

Alfredo Papa ◽

Roberto Persiani ◽

Ricardo Escalante ◽

Enio Chavez De Oliveira ◽

...

Keyword(s):

Surgical Management ◽

Peritoneal Lavage ◽

Elective Surgery ◽

Laparoscopic Approach ◽

Sigmoid Resection ◽

Open Approach ◽

Hartmann Procedure ◽

Elective Resection ◽

Laparoscopic Peritoneal Lavage ◽

Operation Rate

In this session different issues for the surgical management of diverticular disease DD) were considered. The first session debated about the antibiotic treatment for acute uncomplicated diverticulitis (AUD), and supports their use selectively rather than routinely in patients with AUD. The second session discussed the best surgical treatment for those patients. Open approach is a valid choice especially in acute setting, while the laparoscopic approach should be individualised according to the level of skills of the surgeon and the risk factors of the patient (such as obesity and state of health at the time of the operation). The third session debated about the peritoneal lavage and drainage, which is still a safe surgical procedure. However, it requires longer follow-up and results of other trials to draw an adequate conclusion. The last session covers the current surgical certainties in managing complicated DD: 1. urgent colectomy has higher mortality in immune-compromised patients, while in elective surgery is comparable with other populations; 2. laparoscopic peritoneal lavage (LPL) should be the choice in young/fit patients; 3. elective resection is safer in an inflammation free interval; 4. laparoscopic resection shows advantages in several outcomes (such as post-operative morbidity and lower stoma and re-operation rate); 5. in Hinchey III/fecal peritonitis, primary sigmoid resection and anastomosis (open or laparoscopic) could be proposed in young/ fit patient; 6. in case of emergency surgery, Hartmann procedure (open or laparoscopic) must be considered in critically ill/unstable patient.

Download Full-text

P162 Prevalence of nafld (non alcoholic fatty liver disease) and fibrosis in inflammatory bowel disease: the impact of traditional risk factors, intestinal inflammation and genetic phenotype

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.291 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S219-S220

Author(s):

B Scrivo ◽

C Celsa ◽

A Busacca ◽

E Giuffrida ◽

R M Pipitone ◽

...

Keyword(s):

Risk Factors ◽

Inflammatory Bowel Disease ◽

Disease Activity ◽

Bowel Disease ◽

Intestinal Inflammation ◽

Extraintestinal Manifestations ◽

Previous Surgery ◽

Inflammatory Bowel ◽

Traditional Risk Factors

Abstract Background Prevalence of NAFLD has recently been reported increased in inflammatory bowel disease (IBD) with conflicting results due to heterogeneity of published studies, especially in the diagnostic definition of NAFLD. The increased risk of NAFLD might be related to traditional risk factors but also to IBD-related factors. The role of genetic markers has been addressed only in one study. The aim of our study has been to assess the prevalence of NAFLD and fibrosis in a homogeneous cohort of patients with IBD, assessing the role of metabolic, disease-related and genetic factors. Methods the diagnosis of NAFLD was based on transient fibroelastometry findings (CAP ≥288 dB/m) and HSI (Hepatic Steatosis Index). Demographic data, traditional risk factors for NAFLD (BMI, lipid profile), comorbities, laboratory tests, disease features (type of IBD, duration, extent, extraintestinal manifestations, relapses/year, disease activity, previous surgery, therapy) were registered in a dedicated database. PNPLA3 rs738409 C>G single nucleotide polymorphism, encoding for I148M protein variant, was investigated by Taqman assay. Results 208 consecutive patients were enrolled: 120 males, 121 Crohn’s disease, 87 ulcerative colitis, mean age 46,4 ± 15,2 years. 26 patients (12,5%) were on steroids, 121 on biologics. The prevalence of NAFLD was 20,7% with mean HSI being 38,3 ± 4,7.On univariate analysis, patients with NAFLD were older (54,6 ± 11,1 years), had higher BMI (28,1 ± 3,9 vs. 24,1 ± 3,8), had more frequently hypertension and high level of LDL and tryglicerides. No significant difference was found as far as concerns gender, number of relapses, extraintestinal manifestations, disease activity and duration and ongoing therapy. Medium stiffness value was higher in patients with NAFLD (6,4 ± 2,4 vs. 4,8 ± 2,2 KPa). CG phenotype of PNAPL3 was more frequent among NAFLD patients, though the result was not significant. On multivariate analysis age, BMI, previous surgery and level of stiffness > 6,9 kPa were independently related to NAFLD. Conclusion This single center cross-sectional study shows that, by using transient elastography, the prevalence of NAFLD in IBD is 20,7% with a significantly increase of liver stiffness and development of fibrosis. NAFLD was related to traditional risk factors (age, BMI, lipid profile) and to previous ileal resection, the last probably due to changes of gut microbiota. Neither intestinal inflammation and drugs nor genetic testing for PNAPL3 seem to be related to the development of NAFLD. Longitudinal studies are warranted to assess the progression of fibrosis and the role of therapeutic interventions.

Download Full-text