Triple Umbilical Incision for Videlaparoscopic Cholecystectomy

Introduction: The laparoscopic surgery is done by using a single port. You place a device through a single incision between 18mm to 50mm and 3-4 trocars can be used. Our work consists of making 3 little incisions to put the three trocars which measure 5 mm and use conventional instruments that measure 36 cm of length of laparoscopic surgery within the internal limits of the umbilicus. Objective: Describe the surgery technique and evaluate the initial results of a laparoscopic cholecystectomy option through three intraumbilical incisions. Methods: It is a retrospective, descriptive, multicentre and observational study. Since June 2014 to August 2019, 20 patients, 17 females and 3 males, were operated using this method from the age ranges of 16 to 65 years old. The average surgical time was 65 minutes. Results: In all cases the procedures were concluded by the intraumbilical approach. One of the cases had to be re-operated due to intraabdominal bleeding from the posterior branch of the cystic artery. Conclusions: The technique is reproducible; the usual triangulation of the ports is not available. Therefore, fort this technique the surgeon needs to have experience and have had advanced training in laparoscopic surgery. The cases must be selective.

Surgical treatment of chronic pancreatitis complicated by bleeding in cystic cavity

OBJECTIVE. The authors studied the rate of bleeding from cystic cavity of the pancreas and analyzed the completed treatment. MATERIAL AND METHODS. The article presented an experience of treatment of 155 patients with chronic cystic pancreatitis. Pseudocysts complicated by hemorrhage into their cavity in 8 patients. The signs of gastroduodenal and intraabdominal bleeding had 5 patients. RESULTS. Suturing of bleeding vessels, extirpation of the stomach, external drainage of pancreatic cysts and gastrocystoanastomosis were immediately performed in 5 patients. Diagnostic angiography was conducted in order to localize a source of bleeding with subsequent attempt of endovascular occlusion of this vessel in 3 patients. Endovascular occlusion stopped bleeding in 2 cases, though it caused a spiral migration and lethal outcome in one case. CONCLUSIONS. Bleeding from the pancreatic cysts was difficult to diagnose. This pathology left the only surgical method of saving patient in most cases.

Reoperations for Intraabdominal Bleeding Following Deceased Donor Liver Transplantation

Intraabdominal hemorrhage remains one of the most frequent surgical complications after liver transplantation.The aim of the study was to evaluate risk factors for intraabdominal bleeding requiring reoperation and to assess the relevance of the reoperations with respect to short- and long-term outcomes following liver transplantation.Material and methods. Data of 603 liver transplantations performed in the Department of General, Transplant and Liver Surgery in the period between January 2011 and September 2014 were analyzed retrospectively. Study end-points comprised: reoperation due to bleeding and death during the first 90 postoperative days and between 90 postoperative day and third post-transplant year.Results. Reoperations for intraabdominal bleeding were performed after 45 out of 603 (7.5%) transplantations. Low pre-transplant hemoglobin was the only independent predictor of reoperation (p=0.002) with the cut-off of 11.3 g/dl. Postoperative 90-day mortality was significantly higher in patients undergoing reoperation as compared to the remaining patients (15.6% vs 5.6%, p=0.008). Post-transplant survival from 90 days to 3 years was non-significantly lower in patients after reoperation for bleeding (83.3%) as compared to the remaining patients (92.2%, p=0.096). Nevertheless, multivariable analyses did not reveal any significant negative impact of reoperations for bleeding on short-term mortality (p=0.589) and 3-year survival (p=0.079).Conclusions. Surgical interventions due to postoperative intraabdominal hemorrhage do not appear to affect short- and long-term outcomes following liver transplantation. Preoperative hemoglobin concentration over 11.3 g/dl is associated with decreased risk of this complication, yet the clinical relevance of this phenomenon is doubtful

Bleeding Liver Tumor in a Patient on Anticoagulation Therapy – Case Report

Intraabdominal bleeding is a serious surgical problem, particularly in elderly patients following an anticoagulant therapy. It occurs, that abdominal haemorrhage is the first symptom of hepatocellular carcinoma, mostly in Asians and Africans, occasionally in Europeans. The article's author shows a case of an elderly man, treated by Acenocumarolum, in a haemorrhagic shock. During an operation a bleeding liver tumor was revealed. The surgical team performed an effectual tumor resection and stoped the bleeding.